Trends in mortality and morbidity for very low birth weight infants, 1991-1999
Trends in mortality and morbidity for very low birth weight infants, 1991-1999
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DOI：
10.1542/peds.110.1.143
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发表时间：
2002-07-01
期刊：
影响因子：
8
通讯作者：
Soll, RF
中科院分区：
文献类型：
--
作者：
Horbar, JD;Badger, GJ;Soll, RF
背景。20世纪90年代期间，极低出生体重（VLBW）婴儿及其母亲的医疗护理发生了巨大变化，但尚不清楚这些变化如何影响死亡率和发病率。
目的。我们利用佛蒙特牛津网络数据库来确定1991年至1999年出生的极低出生体重婴儿的临床实践和患者预后趋势。
方法。采用逻辑回归分析来评估实践和预后的时间趋势，同时对患者特征进行调整，并考虑医院内病例的聚集情况。
结果。1991年至1999年，网络数据库中登记有来自362个新生儿重症监护病房的118448名体重在501克至1500克的婴儿。在此期间，产前护理、剖宫产、多胎生育、产前使用类固醇以及1分钟阿普加评分有所增加，鼻持续气道正压通气、高频通气、表面活性剂和产后使用类固醇的情况也有所增加。白人婴儿的比例下降；西班牙裔婴儿和其他种族婴儿的比例上升。从1991年到1995年，粗死亡率和校正死亡率、气胸、脑室内出血（IVH）以及严重脑室内出血的发生率下降，而从1995年到1999年，死亡率、脑室内出血以及严重脑室内出血的发生率没有显著变化，气胸发生率增加。
结论。20世纪90年代期间，产科和新生儿护理都发生了重大变化。这些变化与该十年上半年极低出生体重婴儿死亡率和发病率的下降有关。然而，自1995年以来，在死亡率或发病率方面没有看到进一步的改善，结束了这些婴儿预后改善的长达十年的趋势。
Background. Medical care for very low birth weight (VLBW) infants and their mothers has changed dramatically during the 1990s, yet it is unclear how these changes have affected mortality and morbidity.Objective. We used the Vermont Oxford Network Database to identify trends in clinical practice and patient outcomes for VLBW infants born from 1991 to 1999.Methods. Logistic regression was used to evaluate temporal trends in practices and outcomes while adjusting for patient characteristics and accounting for clustering of cases within hospitals.Results. There were 118 448 infants 501 to 1500 g from 362 neonatal intensive care units enrolled in the Network Database from 1991 to 1999. Prenatal care, cesarean section, multiple births, antenatal steroids, and 1-minute Apgar scores increased during this period, as did the use of nasal continuous positive airway pressure, high-frequency ventilation, surfactant, and postnatal steroids. The proportion of white infants decreased; the proportions of Hispanic infants and those of other races increased. The crude and adjusted rates of mortality, pneumothorax, intraventricular hemorrhage (IVH), and severe IVH declined from 1991 to 1995, whereas from 1995 to 1999, the rates of mortality, IVH, and severe IVH did not change significantly, and pneumothorax increased.Conclusions. There have been major changes in both obstetric and neonatal care during the 1990s. These changes were associated with decreases in mortality and morbidity for VLBW infants during the first half of the decade. However, since 1995, no additional improvements in mortality or morbidity have been seen, ending a decades-long trend of improving outcomes for these infants.