Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months - Results from the trial of indomethacin prophylaxis in preterms
Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months - Results from the trial of indomethacin prophylaxis in preterms
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DOI：
10.1001/jama.289.9.1124
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发表时间：
2003-03-05
影响因子：
120.7
通讯作者：
Whitfield, MF
中科院分区：
文献类型：
--
作者：
Schmidt, B;Asztalos, EV;Whitfield, MF
背景尽管对极早产儿的预后研究已有20多年，但临床医生仍不确定新生儿发病率在多大程度上预测极低出生体重儿（ELBW）的不良长期预后。早产儿吲哚美辛预防性治疗试验（TIPP）的初始队列设计背景和参与者共有910名出生体重为500至999 g的婴儿，他们被收入加拿大，美国，澳大利亚，新西兰，主要指标联合终点死亡或生存至18个月，伴1例或1例以上脑性瘫痪、认知延迟、重度听力损失，结果每一种新生儿发病率与18个月的不良结局相似且独立相关。BPD的比值比为2.4（95%置信区间[CI]，1.8-3.2），脑损伤为3.7（95% CI，2.6-5.3），重度ROP为3.1（95% CI，1.9-5.0）。在没有BPD、脑损伤和严重ROP的儿童中，长期预后不良的发生率为18%（95%CI，14%-22%）。任何1种、任何2种和所有3种新生儿发病率的对应率为42%（95% CI，37%-47%），62%（95%CI，53%-70%）和88%（64%-99%）。简单计算3种常见的新生儿发病率，就能很好地预测后期死亡或神经感觉障碍的风险。
Context Despite more than 2 decades of outcomes research after very preterm birth, clinicians remain uncertain about the extent to which neonatal morbidities predict poor long-term outcomes of extremely low-birth-weight (ELBW) infants.Objective To determine the individual and combined prognostic effects of bronchopulmonary dysplasia (BPD), ultrasonographic signs of brain injury, and severe retinopathy of prematurity (ROP) on 18-month outcomes of ELBW infants.Design Inception cohort assembled for the Trial of Indomethacin Prophylaxis in Preterms (TIPP).Setting and Participants A total of 910 infants with birth weights of 500 to 999 g who were admitted to 1 of 32 neonatal intensive care units in Canada, the United States, Australia, New Zealand, and Hong Kong between 1996 and 1998 and who survived to a postmenstrual age of 36 weeks.Main Outcome Measures Combined end point of death or survival to 18 months with 1 or more of cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness.Results Each of the neonatal morbidities was similarly and independently correlated with a poor 18-month outcome. Odds ratios were 2.4 (95% confidence interval [CI], 1.8-3.2) for BPD, 3.7 (95% CI, 2.6-5.3) for brain injury, and 3.1 (95% CI, 1.9-5.0) for severe ROP. In children who were free of BPD, brain injury and severe ROP the rate of poor long-term outcomes was 18% (95% CI, 14%-22%). Corresponding rates with any 1, any 2, and all 3 neonatal morbidities were 42% (95% CI, 37%-47%), 62% (95% CI, 53%-70%), and 88% (64%-99%), respectively.Conclusion In ELBW infants who survive to a postmenstrual age of 36 weeks, a simple count of 3 common neonatal morbidities strongly predicts the risk of later death or neurosensory impairment.