1、早產(chǎn)兒管理現(xiàn)狀與未來Why pay special attention to preterm children為什么要特別關(guān)注早產(chǎn)兒早產(chǎn)兒是全球人類死亡的主要原因之一全世界每年超過300萬新生兒死亡, 并發(fā)癥導(dǎo)致死亡病例中早產(chǎn)兒為35% 兒童5歲以下肺炎死亡病例中,早產(chǎn)兒占位第二, 在中高收入國家則占位第一早產(chǎn)兒也是人類生命過程中遠期死亡重要原因Blencowe et al. Reproductive Health 2013, 10(Suppl 1):S2Preterm baby survival and care round the world全球早產(chǎn)嬰兒生存與管理狀況 Estimated

2、distribution of causes of 3.1 million neonatal deaths in 193 countries in 2010. Source: Updated from Lawn et al., 2005, using data from 2010 published in Liu L, et al., 2012.Blencowe et al. Reproductive Health 2013, 10(Suppl 1):S2Figure 2. Increasing survival gap for preterm babies around the world:

3、 Regional variation in preterm birth as direct cause of neonatal deaths showing change between 2000 to 2010. Source: Born Too Soon, Chapter 5 . Data from Child Health Epidemiology Reference Group and World Health Organization estimates of neonatal causes of death (Liu et al. 2012) .Figure 3. Preterm

4、 births by gestational age and region for the year 2010. Based on Millennium Development Goal regions. Source:Reproduced with permission from Blencowe et al. (2012) National, regional and worldwide estimates of preterm birth rates in the year 2010 withtime trends since 1990 for selected countries: a

5、 systematic analysis and implications. Lancet 379(9832): 2162-2172.Lancet. 2013 January 19; 381(9862): 223234. Overview of defi nitions for preterm birth and related pregnancy outcomes. Source: Reproduced with permission from Blencoweet al. (2012) National, regional and worldwide estimates of preter

6、m birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 379(9832): 2162-2172.The history of neonatal care in the United Kingdom and the United States shows that dramatic declines in neonatal mortality are possible even before

7、neonatal intensive care is scaled up. Source: Born Too Soon, Chapter 5 113. Acroynms used: ANCS = antenatal .Program opportunities for scale up of the care專業(yè)規(guī)模發(fā)展將帶來空間提升早產(chǎn)對幸存者的長期影響Figure 1. 135 million newborns and 15 million premature babies-health system needs and human capital outcomes around the

8、year2010. Source: Born Too Soon report, chapter 5 113. Analysis using data from Blencowe et al., 2012 1; Cousens et al., 2011 114; Liu et al., 2012 8.專業(yè)規(guī)模發(fā)展將帶來提升空間 Program opportunities for scale up of care許多大覆蓋的早產(chǎn)兒數(shù)據(jù)缺乏, 無法為提升干預(yù)水平提供基礎(chǔ)證據(jù), 包括高收入的國家, 故很難評估全球早產(chǎn)兒管理狀況或幾個重要新生兒干預(yù)項目實施情況National coverage data

9、 for many of the evidence-based interventions for premature babies are lacking even in high-income settings, hence it is difficult to assess the global situation for care of premature babies or indeed for several important newborn care interventionsReprod Health. 2013; 10(Suppl 1): S5.Missed opportu

10、nities to reach preterm babies with essential interventions, median for Countdown to 2015 priority countries. Source: Born Too Soon, Chapter 5 . Data sources: Adapted (Kinney et al., 2010) using data from UNICEF Global Databases .What shuold we do next贏得機遇推動早產(chǎn)與早產(chǎn)兒醫(yī)學(xué)發(fā)展推動與發(fā)展策略早產(chǎn)管理: 監(jiān)測與預(yù)警, 預(yù)防與治療提高早產(chǎn)兒復(fù)蘇水平建立等級技術(shù)平臺, 提升不同重癥監(jiān)護病房技術(shù)水平加強早產(chǎn)兒入院前與出院后管理架構(gòu)家長教育體系, 達成社會共識程序1 基礎(chǔ)與額外護理 體溫管理 喂養(yǎng)支持 預(yù)防感染程序2 早產(chǎn)兒復(fù)蘇程序3 袋鼠式護理程序4 特殊護理及重癥監(jiān)護感染黃疸呼吸窘迫綜合征等Percentage of infants with 7-day readmissions according to year of birth.Hosp Pediatr. 20