2023-11-07 インペリアル・カレッジ・ロンドン(ICL)
◆この更新により、イングランドとウェールズで、呼吸器生命支援(生存重視のケア)を受けたり、新生児集中治療室に入院したりする早産児(22週)の数が3倍に増加した。早産児の退院率は向上しているものの、全体的な生存率は低く、追加のリソースニーズに重大な影響があることが研究で明らかになった。
◆この脆弱な乳児群のケアにおける臨床経験が深まるにつれて、転帰を改善し、早期予後因子を特定して、生存の可能性が低い新生児の集中治療の長期化を回避できるようにするために、さらなる国際的な研究が必要であると付け加えている。
<関連情報>
- https://www.imperial.ac.uk/news/249374/number-extremely-premature-babies-receiving-neonatal/
- https://bmjmedicine.bmj.com/content/2/1/e000579
イングランドとウェールズにおける妊娠22週で生まれた赤ちゃんの生存率に対する国のガイダンスの効果:集団ベースのコホート研究 Effect of national guidance on survival for babies born at 22 weeks’ gestation in England and Wales: population based cohort study
Lucy K Smith,Emily van Blankenstein,Grenville Fox,Sarah E Seaton1,Mario Martínez-Jiménez,Stavros Petrou,Cheryl Battersby,MBRRACE-UK Perinatal Surveillance Group UK
BMJ Medicine Published November 7, 2023.
DOI:http://dx.doi.org/10.1136/bmjmed-2023-000579
Abstract
Objectives To explore the effect of changes in national clinical recommendations in 2019 that extended provision of survival focused care to babies born at 22 weeks’ gestation in England and Wales.
Design Population based cohort study.
Setting England and Wales, comprising routine data for births and hospital records.
Participants Babies alive at the onset of care in labour at 22 weeks+0 days to 22 weeks+6 days and at 23 weeks+0 days to 24 weeks+6 days for comparison purposes between 1 January 2018 and 31 December 2021.
Main outcome measures Percentage of babies given survival focused care (active respiratory support after birth), admitted to neonatal care, and surviving to discharge in 2018-19 and 2020-21.
Results For the 1001 babies alive at the onset of labour at 22 weeks’ gestation, a threefold increase was noted in: survival focused care provision from 11.3% to 38.4% (risk ratio 3.41 (95% confidence interval 2.61 to 4.45)); admissions to neonatal units from 7.4% to 28.1% (3.77 (2.70 to 5.27)), and survival to discharge from neonatal care from 2.5% to 8.2% (3.29 (1.78 to 6.09)). More babies of lower birth weight and early gestational age received survival focused care in 2020-21 than 2018-19 (46% to 64% at <500g weight; 19% to 31% at 22 weeks+0 days to 22 weeks+3 days).
Conclusions A change in national guidance to recommend a risk based approach was associated with a threefold increase in 22 weeks’ gestation babies receiving survival focused care. The number of babies being admitted to neonatal units and those surviving to discharge increased.
