EPICure: facts and figures: why preterm labour should be treated
EPICure: facts and figures: why preterm labour should be treated
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DOI：
10.1111/j.1471-0528.2006.01118.x
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发表时间：
2006-12-01
影响因子：
5.8
通讯作者：
Costeloe, K.
中科院分区：
文献类型：
--
作者：
Costeloe, K.
EPICure研究的主要目的是确定极早产的短期和长期结局。1995年，在英国和爱尔兰共和国收集了10个月内所有妊娠26周前出生的数据。在新生儿病房收治的811名婴儿中，314名（39%）存活。其中，283名（92%）在2.5年和241名（78%）在6年进行了评估，以及从正常学校的同学中选择的比较组。在6年时，32名（13%）被评估为致残性脑瘫，31名（13%）有严重的感觉障碍。认知障碍是更常见的不良结局：平均智商（IQ）为82（SD 19）。50名儿童（21%）的智商低于对照组3SD，48名儿童（20%）的智商低于对照组2- 3SD。母亲接受过产前类固醇的婴儿头部扫描发现严重异常的情况较少。在这一人群中，异常头部扫描结果是2.5年时重度运动残疾减轻的独立预测因素。使用逐步logistic回归分析，产后转移与严重的运动障碍，延长胎膜破裂与降低精神发育指数（MDI）和产前类固醇与增加MDI。很明显，无论新生儿重症监护期间的后期并发症如何，出生时周围的因素对决定结果至关重要。自1995年以来，有很好的证据表明生存率有所提高，但尚不清楚具有严重不良后果的生存者人数是否发生了变化。目前正在英国产科单位收集一批新的< 27周的出生婴儿。出生前后的数据收集比1995年更详细，以便更好地探讨围产期因素与后期结果之间的关系。
The principal objective of the EPICure studies was to determine both short- and long-term outcomes of extremely preterm birth. Data were collected for all births before 26 completed weeks of gestation in the UK and Republic of Ireland for 10 months in 1995. Of 811 infants admitted to neonatal units, 314 (39%) survived. Of these, 283 (92%) were assessed at 2.5 years and 241 (78%) at 6 years, together with a comparator group selected from classmates in normal schools. At 6 years, 32 (13%) of those assessed had disabling cerebral palsy and 31 (13%) had severe sensory impairment. Cognitive impairment was a more frequent adverse outcome: the mean intelligence quotient (IQ) was 82 (SD 19). Fifty children (21%) had IQs > 3 SD less than that of the comparator group, and in 48 children (20%), IQ was 2-3 SD less than that of the comparator group. Infants whose mothers had received antenatal steroids had fewer severely abnormal head scan findings. In this population, abnormal head scan findings are independent predictors of reduced, severe motor disability at 2.5 years. Using step-wise logistic regression analysis, postnatal transfer was associated with severe motor disability; prolonged membrane rupture with reduced Mental Development Index (MDI) and antenatal steroid with increased MDI. It is clear that factors around the time of birth are critical in determining outcome, irrespective of later complications during neonatal intensive care. Since 1995, there is good evidence of improved survival, but it is not clear whether or not the number of survivors with severe adverse outcomes has changed. A new cohort of births < 27 completed weeks is currently being collected in English maternity units. Data collection around the time of birth is more detailed than in 1995 in order to better explore the relationship between perinatal factors and later outcomes.