Gestational age- and birthweight-specific declines in infant mortality in Canada, 1985-94
Gestational age- and birthweight-specific declines in infant mortality in Canada, 1985-94
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DOI：
10.1046/j.1365-3016.2000.00298.x
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发表时间：
2000-10-01
影响因子：
2.8
通讯作者：
Wen, SW
中科院分区：
文献类型：
--
作者：
Joseph, KS;Kramer, MS;Wen, SW
我们研究了婴儿死亡率在加拿大的特定胎龄和出生体重类别后，使用概率技术，以连接信息在加拿大统计局的活产数据库（1985-94年）与死亡数据库（1985-95年）。将1992-94年与1985-87年的出生年龄和出生体重特异性死亡率进行对比，并以相对风险和95%置信区间[CI]表示变化。婴儿死亡率从妊娠24-25周开始出现统计学上的显著下降，并在整个胎龄范围内延伸到足月分娩。从1985- 1987年到1992- 1994年，婴儿粗死亡率、体重大于或等于500克的婴儿死亡率和体重大于或等于1 000克的婴儿死亡率分别下降了22%、25%和26%。婴儿死亡率降低的幅度范围为妊娠24-25周时的14% [95% CI 7，21%]至28-31周时的40% [95% CI 31，47%]。1985- 1987年和1992- 1994年之间，几乎所有的胎龄和出生体重特定的婴儿死亡率的下降都是由于新生儿和新生儿后期死亡率的下降大致相等。妊娠大于或等于42周的活产不遵循这一规则;此类活产的新生儿后死亡率显著下降了51% [95%CI 26，68%]，尽管新生儿死亡率没有显著变化。在胎龄和出生体重范围内观察到的死亡率降低可能是特定临床干预补充胎儿生长改善的结果。过期妊娠的结果的时间变化需要仔细检查，特别是在最近的变化，产科管理这样的怀孕。
We studied infant mortality rates in Canada within specific gestational age and birthweight categories after using probabilistic techniques to link information in Statistics Canada's live births data base (1985-94) with that in the death data base (1985-95). Gestational age- and birthweight-specific mortality rates in 1992-94 were contrasted with those in 1985-87 with changes expressed in terms of relative risks with 95% confidence intervals [CI]. Statistically significant reductions in infant mortality were observed beginning at 24-25 weeks of gestation and extended across the gestational age range to post-term births. Crude infant mortality rates, infant mortality rates among those greater than or equal to 500 g and among those greater than or equal to 1000 g decreased by 22%, 25% and 26%, respectively, from 1985-87 to 1992-94. The magnitude of the reductions in infant mortality rates ranged from 14% [95% CI 7, 21%] at 24-25 weeks of gestation to 40% [95% CI 31, 47%] at 28-31 weeks. Almost all reductions in gestational age- and birthweight-specific infant mortality between 1985-87 and 1992-94 were due to approximately equal reductions in neonatal and post-neonatal mortality. Live births greater than or equal to 42 weeks of gestation did not follow this rule; post-neonatal mortality rates among such live births decreased significantly by 51% [95% CI 26, 68%], although neonatal mortality rates showed no significant change. The mortality reductions observed across the gestational age and birthweight range are probably a consequence of specific clinical interventions complementing improvements in fetal growth. Temporal changes in the outcome of post-term pregnancies need to be carefully examined, especially in relation to recent changes in the obstetric management of such pregnancies.