THE CONTRIBUTION OF LOW BIRTH-WEIGHT TO INFANT-MORTALITY AND CHILDHOOD MORBIDITY
THE CONTRIBUTION OF LOW BIRTH-WEIGHT TO INFANT-MORTALITY AND CHILDHOOD MORBIDITY
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DOI：
10.1056/nejm198501103120204
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发表时间：
1985-01-01
影响因子：
158.5
通讯作者：
MCCORMICK, MC
中科院分区：
文献类型：
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作者：
MCCORMICK, MC
出生时体重不足的婴儿的死亡风险仍然比出生时体重正常的婴儿高得多。新生儿期是婴儿死亡最多的时期，出生体重不足的婴儿，特别是体重极轻的婴儿的比例是死亡率高低的主要决定因素。此外，低出生体重率的差异也是某些群体新生儿死亡率较高的原因，特别是那些社会经济条件不利的群体。最近新生儿死亡率下降的主要原因是低出生体重婴儿的存活率提高，这显然是医院提供服务的结果。目前认为这些服务的应用具有成本效益，但由于极小婴儿存活率的提高，今后是否会继续如此尚不清楚。虽然低出生体重婴儿的新生儿后期死亡率和婴儿期及幼儿期发病率的风险仍然增加，但这种风险大大低于新生儿死亡的风险。此外，这些不利的后期结果并没有抵消在新生儿期取得的成果。尽管如此，高危婴儿存活率的提高使人们对他们今后需要特殊医疗和教育服务以及对其家庭的压力感到关切。尽管获得产前服务的机会有所增加，但出生体重不足婴儿的比例仅略有下降，出生时体重极低婴儿的比例几乎没有变化。此外，在国内许多地区，新生儿死亡风险高和低的群体中，按出生体重划分的新生儿死亡率相似。鉴于这些调查结果，要使目前新生儿死亡率继续下降，并缩小高危和低危群体之间的死亡率差距，就必须确定并更有效地执行预防出生体重不足的战略。
The low-birth-weight infant remains at much higher risk of mortality than the infant with normal weight at birth. In the neonatal period, when most infant deaths occur, the proportion of low-birth-weight infants, especially those with very low weight, is the major determinant of the magnitude of the mortality rates. Furthermore, differences in low-birth-weight rates account for the higher neonatal mortality rates observed in some groups, particularly those characterized by socioeconomic disadvantages. Much of the recent decline in neonatal mortality can be attributed to increased survival among low-birth-weight infants, apparently as a result of hospital-based services. The application of these services is currently considered cost-effective, although whether this will continue to be true in the future is unclear because of the increased survival of very tiny infants. Although low-birth-weight infants remain at increased risk of both postneonatal mortality and morbidity in infancy and early childhood, the risk is substantially smaller than that of neonatal death. In addition, these adverse later outcomes have not offset the gains achieved in the neonatal period. Nonetheless, the increased survival of high-risk infants raises concern about their future requirements for special medical and educational services and about the stress on their families. Despite increased access to antenatal services, only moderate declines in the proportion of low-birth-weight infants has been observed, and almost no change has occurred in the proportion of those with very low weight at birth. In addition, in many areas of the country the birth-weight-specific neonatal mortality rates are similar for groups at high and low risk of neonatal death. In view of these findings, continuation of the current decline in neonatal mortality and reduction of the mortality differentials between high-and low-risk groups require the identification and more effective implementation of strategies for the prevention of low-weight births.