Actuarial survival of a large Canadian cohort of preterm infants.
Actuarial survival of a large Canadian cohort of preterm infants.
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DOI：
10.1186/1471-2431-5-40
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发表时间：
2005-11-09
期刊：
影响因子：
2.4
通讯作者：
Lee, Shoo K
中科院分区：
文献类型：
--
作者：
Jones, Huw P;Karuri, Stella;Cronin, Catherine M G;Ohlsson, Arne;Peliowski, Abraham;Synnes, Anne;Lee, Shoo K
近年来，早产儿和极低出生体重儿的存活率有所提高，这已得到充分证明，但需要继续监测，以监测新的治疗干预措施的效果。妊娠和出生体重特异性存活率最准确地反映了围产期保健的结果。我们的目的是确定存活出院的一个大型加拿大队列的早产儿入院新生儿重症监护室（NICU），并检查性别对生存的影响和影响的出生后年龄增加预测的生存。前瞻性地收集了1996年1月至1997年10月期间在加拿大17个NICU住院的所有19,507名婴儿的结局。研究人群中排除了先天性畸形婴儿。记录了所有出生体重<1，500 g（n = 3419）或妊娠≤30周（n = 3119）的婴儿的妊娠和出生体重特定存活率。精算生存曲线的构建显示预期生存的变化与出生后年龄的增加。妊娠24周时出院存活率为54%，而妊娠26周时为82%，妊娠30周时为95%。在出生体重600-699 g的婴儿中，出院存活率为62%，而700-799 g为79%，1，000 - 1，099 g为96%。在胎龄24周出生的婴儿中，女性的存活率较高，但在胎龄24周以上没有显著的性别差异。精算分析表明，死亡风险在前5天最高。孕24周出生的婴儿48小时、7天和4周的估计生存概率分别为88（CI 84，92）%、70（CI 64，76）%和60（CI 53，66）%。对于出生体重较小的婴儿，在出生后的前40天内，女性的存活概率高于男性。精算分析在咨询父母时提供了有用的信息，并强调了经常修改长期生存预测的重要性，特别是在生命的最初几天之后。
The increased survival of preterm and very low birth weight infants in recent years has been well documented but continued surveillance is required in order to monitor the effects of new therapeutic interventions. Gestation and birth weight specific survival rates most accurately reflect the outcome of perinatal care. Our aims were to determine survival to discharge for a large Canadian cohort of preterm infants admitted to the neonatal intensive care unit (NICU), and to examine the effect of gender on survival and the effect of increasing postnatal age on predicted survival. Outcomes for all 19,507 infants admitted to 17 NICUs throughout Canada between January 1996 and October 1997 were collected prospectively. Babies with congenital anomalies were excluded from the study population. Gestation and birth weight specific survival for all infants with birth weight <1,500 g (n = 3419) or gestation ≤30 weeks (n = 3119) were recorded. Actuarial survival curves were constructed to show changes in expected survival with increasing postnatal age. Survival to discharge at 24 weeks gestation was 54%, compared to 82% at 26 weeks and 95% at 30 weeks. In infants with birth weights 600–699, survival to discharge was 62%, compared to 79% at 700–799 g and 96% at 1,000–1,099 g. In infants born at 24 weeks gestational age, survival was higher in females but there were no significant gender differences above 24 weeks gestation. Actuarial analysis showed that risk of death was highest in the first 5 days. For infants born at 24 weeks gestation, estimated survival probability to 48 hours, 7 days and 4 weeks were 88 (CI 84,92)%, 70 (CI 64, 76)% and 60 (CI 53,66)% respectively. For smaller birth weights, female survival probabilities were higher than males for the first 40 days of life. Actuarial analysis provides useful information when counseling parents and highlights the importance of frequently revising the prediction for long term survival particularly after the first few days of life.