Intrauterine growth restriction increases morbidity and mortality among premature neonates
Intrauterine growth restriction increases morbidity and mortality among premature neonates
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DOI：
10.1016/j.ajog.2004.01.036
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发表时间：
2004-08-01
影响因子：
9.8
通讯作者：
Thorp, James A.
中科院分区：
文献类型：
--
作者：
Garite, Thomas J.;Clark, Reese;Thorp, James A.
目的：宫内生长受限（IUGR）是早产的一个重要原因，据报道与死亡率增加有关，但在一些研究中矛盾的是，它却改善了发病率。目前尚缺乏大量分娩后各适龄孕龄 IUGR 婴儿的新生儿结局数据。更具体地说，与新生儿诊断相比，与 IUGR 产前诊断相关的围产期结局数据特别缺乏。因此，通过使用大型当代数据库，我们评估了 IUGR 新生儿的结果以及生长受限、发病率和死亡率之间特定胎龄的关联。研究设计：通过使用由计算机辅助工具形成的数据库，该数据库生成新生儿重症监护病房 (NICU) 入院的临床进展记录和出院摘要，我们回顾了 1997 年 1 月 1 日至 12 月期间从 124 个 NICU 出院的新生儿的数据2001 年 12 月 31 日。我们评估了分娩 23 至 34 周的单胎出生新生儿，排除重大先天异常。我们比较了 - IUGR 的测量：产前诊断的 IUGR；出生体重低于第 10 个百分位数（小于胎龄 [SGA]），以及患有这两种诊断之一或两种的新生儿，而对照组的胎龄匹配婴儿出生体重不超过第 90 个百分位数，但不符合这些标准。 结果：我们的样本包括 29,916 名早产新生儿； 1,451 名 (4.8%) 患有 IUGR，2,936 名 (9.8%) 患有 SGA，-,708 名 (12.3%) 至少有这 2 个标记中的 1 个。有 22,798 名 (76%) 正常生长的对照新生儿。在 25 至 32 周的每个胎龄组中，IUGR 的每个标志物都与死亡率增加、坏死性小肠结肠炎、28 日龄时需要呼吸支持以及早产儿视网膜病变相关。当校正胎龄、产前类固醇暴露、性别和分娩方式后，这些关联仍然很重要。结论：IUGR 仍然是一个严重的问题，与早产新生儿发病率和死亡率增加有关，无论使用什么定义，也无论诊断是在产前还是出生后进行。这些结果对于产科咨询和决策以及早产儿的预期和治疗非常重要。 (C) 2004 Elsevier Inc. 保留所有权利。
Objective: Intrauterine growth restriction (IUGR) is an important reason for premature delivery and has been reported to be associated with increased mortality, but in some studies paradoxically, improved morbidities. Data on neonatal outcomes for infants with IUGR at each viable gestational age at birth from large numbers of deliveries are lacking. More particularly, data on perinatal outcome related to an antenatal diagnosis of IUGR compared with a neonatal diagnosis are particularly deficient. Therefore, by using a large contemporary database, we evaluated the outcomes of neonates with IUGR and the gestational age-specific associations between growth restriction, morbidity, and mortality.Study design: With the use of a database formed from a computer-assisted tool that generates clinical progress notes and discharge summaries on neonatal intensive care unit (NICU) admissions, we reviewed data on neonates discharged from 124 NICUs between January 1, 1997, and December 31, 2001. We evaluated singleton, inborn neonates who delivered between 23 and 34 weeks, excluding major congenital anomalies. We compared - measures of IUGR: antenatally diagnosed IUGR; a birth weight below the 10th percentile (small for gestational age [SGA]), and newborn infants with either or both of these diagnoses against a control group of gestational age-matched infants meeting none of these criteria whose birth weights were no greater than the 90th percentile.Results: Our sample included 29,916 prematurely born neonates; 1,451 (4.8%) with IUGR, 2,936 (9.8%) who were SGA, and -,708 (12.3%) had at least 1 of these 2 markers. There were 22,798 (76%) normally grown control neonates. Within each gestational age group from 25 to 32 weeks, each marker of IUGR was associated with increased mortality, necrotizing enterocolitis, need for respiratory support at 28 days of age, and retinopathy of the premature. When corrected for gestational age, exposure to antenatal steroids, gender, and mode of delivery, these associations remained signi. cant.Conclusion: IUGR remains a serious problem that is associated with increased morbidity and mortality among prematurely born neonates, regardless of the definition used or whether the diagnosis is made antenatally or after birth. These results are important for obstetric counseling and decision making and for the anticipation and treatment of premature newborn infants. (C) 2004 Elsevier Inc. All rights reserved.