Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000-2002
Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000-2002
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DOI：
10.1542/peds.2006-1416
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发表时间：
2007-01-01
期刊：
影响因子：
8
通讯作者：
Hack, Maureen
中科院分区：
文献类型：
--
作者：
Wilson-Costello, Deanne;Friedman, Harriet;Hack, Maureen
背景。 20 世纪 90 年代，极低出生体重婴儿的神经发育障碍有所增加。现代治疗方法的改变可能影响了最近的新生儿结局。 目的。我们试图将 2000 - 2002 年（第三期）出生的所有极低出生体重婴儿的新生儿治疗和结果与之前的两个时期：1982 - 1989 年（第一期）和 1990 - 1999 年（第二期）进行比较。方法。人群包括第一期在我们围产中心出生的 496 名极低出生体重婴儿、第二期出生的 749 名极低出生体重婴儿和第三期出生的 233 名极低出生体重婴儿。比较了 20 个月校正年龄时的治疗方法、死亡率以及有损伤和无损伤的生存率。结果。在 I 期和 II 期之间，存活率从 49% 增加到 68%，新生儿发病率也从 49% 增加到 68%。这导致无损伤的生存率增加，但也导致有损伤的生存率增加。第三阶段治疗的变化包括产前类固醇使用的增加和产后类固醇使用的减少，尽管慢性肺病的发生率没有变化。败血症和严重脑室内出血的发生率均有所下降。随访中，脑瘫发生率从 13% 下降到 5%，神经发育障碍从 35% 下降到 23%。结果，在第 III 期与第 II 期相比，无损伤的生存率增加，而有损伤的生存率下降。结论。自 2000 年以来，极低出生体重婴儿的神经发育障碍有所减少。多种围产期和新生儿因素与结局的改善相关，包括产前类固醇使用和剖宫产的增加，以及败血症、严重颅骨超声异常和产后类固醇使用的减少，尽管慢性肺病的发生率没有变化。
BACKGROUND. Neurodevelopmental impairment of extremely low birth weight infants increased in the 1990s. Modern therapeutic changes may have influenced more recent neonatal outcomes.OBJECTIVE. We sought to compare neonatal therapies and outcomes among all extremely low birth weight infants born in 2000 - 2002 (period III) to 2 previous periods: 1982 - 1989 (period I) and 1990 - 1999 (period II).METHODS. The population included 496 extremely low birth weight infants born at our perinatal center during period I, 749 during period II, and 233 during period III. Therapies, rates of death, and survival with and without impairment at 20 months' corrected age were compared.RESULTS. Between periods I and II, survival increased from 49% to 68% as did neonatal morbidity. This resulted in increased survival without impairment but also increased survival with impairment. Changes in therapy during period III included an increase in antenatal steroid use and a decrease in postnatal steroid use, although the rate of chronic lung disease did not change. Sepsis decreased, as did severe intraventricular hemorrhage. On follow-up, the rate of cerebral palsy decreased from 13% to 5%, resulting in a decrease in neurodevelopmental impairment from 35% to 23%. As a result, during period III versus II, survival without impairment increased, whereas survival with impairment decreased.CONCLUSION. Since 2000, neurodevelopmental impairment has decreased among extremely low birth weight infants. A variety of perinatal and neonatal factors were associated with the improved outcomes including increased antenatal steroid use and cesarean section delivery, as well as decreased sepsis, severe cranial ultrasound abnormalities, and postnatal steroid use despite no change in the rate of chronic lung disease.