Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Network.
Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Network.
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国家儿童健康和人类发展研究所新生儿网络的极低出生体重结果。
DOI：
10.1542/peds.87.5.587
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发表时间：
1991
期刊：
影响因子：
8
通讯作者：
L. Wright
中科院分区：
文献类型：
--
作者：
M. Hack;J. Horbar;M. Malloy;J. Tyson;Elizabeth C. Wright;L. Wright
本报告描述了从1987年11月至1988年10月在国家儿童健康和人类发育研究所新生儿重症监护网络的七个参与中心分娩的1765例极低出生体重（小于1500 g）婴儿的新生儿结局。出生体重小于751 g时的存活率为34%（中心间范围为20%-55%），751 - 1000 g时为66%（范围为42%-75%），1001 - 1250 g时为87%（范围为84%-91%），1251 - 1500 g时为93%（范围为89%-98%）。通过产科妊娠指标，23周时生存率为23%（范围0%至33%），24周时为34%（范围10%至57%），25周时为54%（范围30%至72%）。新生儿发病率包括呼吸窘迫（67%）、症状性动脉导管未闭（25%）、坏死性小肠结肠炎（6%）、败血症（17%）、脑膜炎（2%）、尿路感染（4%）和脑室内出血（45%，18%为III级和IV级）。发病率随着出生体重的降低而增加。79%的出生体重小于751 g的婴儿（中心之间的范围为67%至100%）、45%的751至1000 g的婴儿（范围为20%至68%）和13%的1001至1500 g的婴儿（范围为5%至23%）接受了大于或等于28天的氧气给药。68%的婴儿在小于751 g时给予大于或等于28天的呼吸机支持，29%的婴儿在751至1000 g时给予呼吸机支持，4%的婴儿在大于1000 g时给予呼吸机支持。存活者住院时间为59天，而死亡婴儿住院时间为15天。69%的幸存者在出院时体重低于正常（低于第10百分位数）。这些数据表明，目前新生儿结局的重要中心间差异，以及护理理念和发病率的定义和患病率的差异。
This report describes the neonatal outcomes of 1765 very low birth weight (less than 1500 g) infants delivered from November 1987 through October 1988 at the seven participating centers of the National Institute of Child Health and Human Development Neonatal Intensive Care Network. Survival was 34% at less than 751 g birth weight (range between centers 20% to 55%), 66% at 751 through 1000 g (range 42% to 75%), 87% at 1001 through 1250 g (range 84% to 91%), and 93% at 1251 through 1500 g (range 89% to 98%). By obstetric measures of gestation, survival was 23% at 23 weeks (range 0% to 33%), 34% at 24 weeks (range 10% to 57%), and 54% at 25 weeks (range 30% to 72%). Neonatal morbidity included respiratory distress (67%), symptomatic patent ductus arteriosus (25%), necrotizing enterocolitis (6%), septicemia (17%), meningitis (2%), urinary tract infection (4%), and intraventricular hemorrhage (45%, 18% grade III and IV). Morbidity increased with decreasing birth weight. Oxygen was administered for greater than or equal to 28 days to 79% of less than 751-g birth weight infants (range between centers 67% to 100%), 45% of 751- through 1000-g infants (range 20% to 68%), and 13% of 1001- through 1500-g infants (range 5% to 23%). Ventilator support for greater than or equal to 28 days was given to 68% of infants at less than 751 g, 29% at 751 through 1000 g, and 4% at greater than 1000 g. Hospital stay was 59 days for survivors vs 15 days for infants who died. Sixty-nine percent of survivors had subnormal (less than 10th percentile) weight at discharge. The data demonstrate important intercenter variation of current neonatal outcomes, as well as differences in philosophy of care and definition and prevalence of morbidity.