The influence of the wider use of surfactant therapy on neonatal mortality among blacks and whites
The influence of the wider use of surfactant therapy on neonatal mortality among blacks and whites
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DOI：
10.1056/nejm199606203342504
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发表时间：
1996-06-20
影响因子：
158.5
通讯作者：
Cole, FS
中科院分区：
文献类型：
--
作者：
Hamvas, A;Wise, PH;Cole, FS
背景。表面活性剂治疗可降低呼吸窘迫综合征（RDS）早产儿的发病率和死亡率。胎儿肺表面活性剂在白人胎儿中比在黑人胎儿中成熟得慢，因此RDS在白人中比在黑人中更普遍。我们推断，表面活性剂在1990年获得美国食品和药物管理局（FDA）的批准后，其使用的增加可能比黑人更能降低白人的新生儿死亡率。我们将圣路易斯居民1987年至1989年或1991年至1992年出生的所有1563名极低出生体重（500至1500克）婴儿的生命统计信息与圣路易斯地区四个新生儿重症监护病房的临床数据合并；然后我们比较了两个时期的新生儿死亡率，一个是在FDA批准表面活性剂用于临床使用之前和之后（1987年至1989年和1991年至1992年）。表面活性剂的使用在1987年至1989年和1991年至1992年之间增加了10倍，所有极低出生体重婴儿的新生儿死亡率下降了17%，从每1000名极低出生体重婴儿死亡220.3例（1987年至1989年）降至每1000名183.9例（1991年至1992年；P = 0.07）。这是由于出生体重极低的白人新生儿的死亡率降低了41%（从261.5‰降至155.5‰；P = 0.003）。相比之下，在黑人婴儿中，出生体重极低婴儿的死亡率没有显著变化（每1000人中有195.6人和每1000人中有196.8人）。1987年至1989年，出生体重极低的黑人新生儿与体重相似的白人新生儿相比的相对死亡风险为0.7,1991年至1992年为1.3 （P = 0.02）。死亡率的差异不能用表面活性剂治疗的可及性差异、接受表面活性剂治疗的黑人和白人婴儿死亡率的差异或产前皮质类固醇治疗使用的差异来解释。表面活性剂治疗RDS普遍可用后，出生体重非常低的白人婴儿的新生儿死亡率比黑人婴儿改善得更多。(C) 1996年，马萨诸塞州医学会。
Background. Surfactant therapy reduces morbidity and mortality among premature infants with the respiratory distress syndrome (RDS). Fetal pulmonary surfactant matures more slowly in white than in black fetuses, and therefore RDS is more prevalent among whites than among blacks. We reasoned that the increased use of surfactant after its approval by the Food and Drug Administration (FDA) in 1990 might have reduced neonatal mortality more among whites than among blacks.Methods. We merged vital-statistics information for all 1563 infants with very low birth weights (500 to 1500 g) born from 1987 through 1989 or in 1991 and 1992 to residents of St. Louis with clinical data from the four neonatal intensive care units in the St. Louis area; we then compared neonatal mortality during two periods, one before and one after the FDA's approval of surfactant for clinical use (1987 through 1989 and 1991 through 1992).Results. The use of surfactant increased by a factor of 10 between 1987 through 1989 and 1991 through 1992, The neonatal mortality rate among all very-low-birthweight infants decreased 17 percent, from 220.3 deaths per 1000 verv-low-birth-weight babies born alive (in 1987 through 1989) to 183.9 per 1000 (in 1991 through 1992; P = 0.07). This decrease was due to a 41 percent reduction in the mortality rate among white newborns with very low birth weights (from 261.5 per 1000 to 155.5 per 1000; P = 0.003). In contrast, among black infants, the mortality rate for very-low-birth-weight infants did not change significantly (195.6 per 1000 and 196.8 per 1000). The relative risk of death among black newborns with very low birth weights as compared with white newborns with similar weights was 0.7 from 1987 through 1989 and 1.3 from 1991 through 1992 (P = 0.02). The differences in mortality were not explained by differences in access to surfactant therapy, by differences in mortality between black and white infants who received surfactant, or by differences in the use of antenatal corticosteroid therapy.Conclusions. After surfactant therapy for RDS became generally available, neonatal mortality improved more for white than for black infants with very low birth weights. (C) 1996, Massachusetts Medical Society.