Changes in mortality for extremely low birth weight infants in the 1990s: Implications for treatment decisions and resource use
Changes in mortality for extremely low birth weight infants in the 1990s: Implications for treatment decisions and resource use
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DOI：
10.1542/peds.113.5.1223
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发表时间：
2004-05-01
期刊：
影响因子：
8
通讯作者：
Lantos, J
中科院分区：
文献类型：
--
作者：
Meadow, W;Lee, G;Lantos, J
客观的。过去十年，新生儿重症监护病房 (NICU) 护理发生了很大变化。高频振荡、吸入一氧化氮和产前皮质类固醇现在已广泛使用。我们想知道这些医学进步如何影响 NICU 中极低出生体重 (ELBW) 婴儿的流行病学和生死伦理。方法。我们确定了 1991 年至 2001 年间连续入住我们 NICU 的 1142 名 ELBW 婴儿（出生体重 [BW] < 1000 g）。我们提取了 BW、胎龄、生存或死亡以及 NICU 住院时间。通过使用线性回归和双向方差分析进行统计分析。结果。增加体重和晚年都与提高生存率显着相关。然而，对于较大的 ELBW 婴儿，整个十年的生存率接近 90%，而且大规模改善几乎是不可能的。对于较小的婴儿来说，至少在本世纪初，更大的改善是可能的，也被观察到。从 1991 年到 1997 年，总体 ELBW 存活率稳步上升（每年增加 4%）。然而，从1997年到2001年，ELBW婴儿的生存率没有显着改善。从 1991 年到 2001 年，ELBW 人群中 BW 亚组的死亡分布没有变化。最终在出院前过期的婴儿的中位住院时间从 1991 年的 2 天增加到 2001 年的 10 天。因此，在过去十年中，在生命第 4 天“未申报”结果的 ELBW 婴儿的百分比从 10% 上升到 20%总体而言，体重为 450 至 700 克的婴儿的这一比例为 33%。从 1991 年到 2001 年，非幸存者占据 ELBW NICU 床位日的百分比仍然非常低（接近 7%）。结论。 1) 与十年前相比，所有 ELBW 亚组中的婴儿死亡人数有所减少，并且体重为 450 至 700 克的婴儿的改善最为显着，该年龄段的死亡率过去是并且仍然是最高的。 2) 到本世纪末，这一进展似乎已经放缓，甚至停止。 3) 虽然大多数新生儿重症监护病房的非幸存者仍然过早死亡，但注定要死的婴儿的存活时间更长。 4) 死亡者继续占据新生儿重症监护室床位的固定（且极小）比例。
Objective. Much has changed in neonatal intensive care unit (NICU) care over the past decade. High-frequency oscillation, inhaled nitric oxide, and antenatal corticosteroids are now widely available. We wondered how these medical advances had affected both the epidemiology and ethics of life and death for extremely low birth weight (ELBW) infants in the NICU.Methods. We identified 1142 ELBW infants (birth weight [BW] < 1000 g) consecutively admitted to our NICU between 1991 and 2001. We abstracted BW, gestational age, survival or death, and length of stay in the NICU. Statistical analyses were performed by using linear regression and 2-way analysis of variance.Results. Both increasing BW and later year were significantly associated with improved survival. However, for larger ELBW infants, survival was similar to 90% for the entire decade, and large-scale improvement was hardly possible. For smaller infants, greater improvements were both possible and observed, at least early in the decade. From 1991 to 1997, overall ELBW survival increased steadily (similar to 4% per year). However, from 1997 to 2001, there was no significant improvement in survival for ELBW infants. There was no change in the distribution of deaths accounted for by BW subgroups within the ELBW population from 1991 to 2001. Median length of stay for infants who eventually expired before discharge rose from 2 days in 1991 to 10 days in 2001. As a consequence, during the past decade, the percentage of infants whose outcome was "undeclared" by day of life 4 rose from 10% to 20% for ELBW infants overall and to 33% for infants with BWs of 450 to 700 g. The percentage of ELBW NICU bed-days occupied by nonsurvivors remained very low (similar to 7%) from 1991 to 2001.Conclusions. 1) Fewer infants in all ELBW subgroups are dying, compared with a decade ago, and the improvement has been most prominent for BWs of 450 to 700 g, at which mortality was and remains to be greatest. 2) This progress seems to have slowed, or even stopped, by the end of the decade. 3) Although most NICU nonsurvivors still expire early, doomed infants are lingering longer. 4) Nonsurvivors continue to occupy a constant (and extremely small) fraction of NICU bed-days.