Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort.
Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort.
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DOI：
10.1016/j.ajog.2016.01.004
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发表时间：
2016-07
影响因子：
9.8
通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
中科院分区：
文献类型：
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作者：
Manuck TA;Rice MM;Bailit JL;Grobman WA;Reddy UM;Wapner RJ;Thorp JM;Caritis SN;Prasad M;Tita AT;Saade GR;Sorokin Y;Rouse DJ;Blackwell SC;Tolosa JE;Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
尽管在美国，小于37孕周的早产是新生儿发病率和死亡率的主要原因，但有关早产新生儿结局的大多数数据来自较早的研究，许多报告仅限于极早产新生儿。需要通过分娩胎龄来描述新生儿结局，以进一步阐明早产儿死亡率和发病率的连续性。我们试图描述新生儿死亡的频率，新生儿发病率，新生儿住院时间在早产胎龄的频谱。对2008-2011年在全国25家医院出生的115，502名妇女及其新生儿的产科队列进行了二次分析。所有活产非异常单胎早产儿（妊娠23.0-36.9周）均纳入本分析。新生儿死亡率、新生儿主要发病率（脑室内出血III/IV级、癫痫发作、缺氧缺血性脑病、坏死性小肠结肠炎II/III期、支气管肺发育不良、持续性肺动脉高压）和轻度新生儿发病率（需要治疗的低血压，1/2级脑室内出血，1期坏死性小肠结肠炎，呼吸窘迫综合征，需要治疗的高胆红素血症）按分娩胎龄计算;每个新生儿按其符合标准的最差结局分类一次。8，334例分娩符合入选标准。新生儿死亡119例（1.4%）。657例（7.9%）新生儿有严重发病率，3,136例（37.6%）有轻微发病率，4,422例（53.1%）存活，无任何研究的发病率。随着妊娠周数的增加，死亡率迅速下降。死亡率的下降伴随着新生儿主要发病率的增加，在妊娠25周时达到54.8%的峰值。随着死亡率和新生儿主要发病率的下降，新生儿次要发病率增加，在妊娠31周时达到81.7%的峰值。所有发病率的频率下降超过32周。新生儿住院时间随妊娠每增加一周而显著缩短;在妊娠26至32周分娩的婴儿中，子宫内每增加一周，新生儿随后住院时间至少减少8天。对于妊娠32-33周出生的婴儿，月经后出院年龄的中位数在月经后35.7周时达到最低点。我们的数据显示，妊娠期每增加一周，在减少初始住院时间的同时，也会增加生存率。这些当代的数据可以为患者咨询早产的结果是有用的。
Although preterm birth less than 37 weeks gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates. We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages. Secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008–2011. All live born non-anomalous singleton preterm (23.0–36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade 1/2, necrotizing enterocolitis stage 1, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome they met criteria for. 8,334 deliveries met inclusion criteria. There were 119 neonatal deaths (1.4%). 657 (7.9%) neonates had major morbidity, 3,136 (37.6%) had minor morbidity, and 4,422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25 weeks of gestation. As frequencies of death, and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31 weeks of gestation. The frequency of all morbidities fell beyond 32 weeks. Neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26 to 32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median post-menstrual age at discharge nadired at 35.7 weeks post-menstrual age for babies born at 32–33 weeks of gestation. Our data show that there is a continuum of outcomes, with each additional week for gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.