Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g
Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g
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DOI：
10.1001/jamapediatrics.2019.0180
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发表时间：
2019-05-01
期刊：
影响因子：
26.1
通讯作者：
Romano, Elaine
中科院分区：
文献类型：
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作者：
Brumbaugh, Jane E.;Hansen, Nellie I.;Romano, Elaine
重要出生体重(BW)是死亡率和发病率的重要预测指标。在极早期胎龄(GAS)，体重可能会影响开始复苏的决定。目的为了表征体重小于400克的活产婴儿的结局，背景和参与者这项回溯性多中心队列研究分析了2008年1月至2016年12月在国家儿童健康和人类发育新生儿研究网络中出生的极早产儿。研究对象为体重小于400克、胎龄22至26周的婴儿。积极治疗被定义为在出生后提供任何潜在的挽救生命的干预措施。对整个队列的存活率进行了分析；对2008年1月至2015年12月(出生年份可供分析)之间出生的人进行了神经发育障碍(NDI)检查。18~26个月矫正年龄(CA)的神经发育障碍定义为Bayley婴幼儿发育量表第三版，认知综合评分<85分，运动综合评分<85分，中重度脑性瘫痪，粗大运动功能分类系统评分2分或以上，双眼失明和/或听力障碍。分析了2017年9月至2018年10月的数据。分析了出生体重低于400克MAIN的结果和测量结果，主要结果是接受积极治疗的婴儿存活到出院。对跟踪数据的分析仅限于2008年至2015年出生的婴儿，以确保儿童已达到评估年龄。结果205例中，121例(59.0%)为女性，133例(64.9%)为单胎，178例(86.8%)小于胎龄。几乎一半(101/205[49.3%])在出生时接受了积极治疗。205名婴儿中共有26名(12.7%；95%CI，8.5-18.9)存活到出院，101名积极治疗的婴儿中有26名(25.7%；95%CI，17.6-35.4)存活到出院。在体重小于400g和GA为22-23周的婴儿亚组中，36名积极治疗的婴儿中有6名(17%；95%可信区间，6-33)存活到出院。在2008年至2015年期间出生的婴儿中，90名积极接受治疗的婴儿中有23名(26%；95%CI，17-36岁)存活到出院。2名婴儿出院后死亡，2名失访。因此，在90名积极接受治疗的婴儿中，有19名(21%；95%CI，13-31)在18至26个月的CA时进行了评估。19例新生儿中有14例发生中、重度NDI(74%)。结论出生体重小于400g的新生儿死亡风险高，发病率高。虽然21%的婴儿通过积极治疗存活到18-26个月的CA，但NDI在幸存者中很常见。
IMPORTANCE Birth weight (BW) is an important predictor of mortality and morbidity. At extremely early gestational ages (GAs), BW may influence decisions regarding initiation of resuscitation.OBJECTIVE To characterize outcomes of liveborn infants with a BW less than 400 g.DESIGN, SETTING, AND PARTICIPANTS This retrospective multicenter cohort study analyzed extremely preterm infants born between January 2008 and December 2016 within the National Institute of Child Health and Human Development Neonatal Research Network. Infants with a BW less than 400 g and a GA of 22 to 26 weeks were included. Active treatment was defined as the provision of any potentially lifesaving intervention after birth. Survival was analyzed for the entire cohort; neurodevelopmental impairment (NDI) was examined for those born between January 2008 and December 2015 (birth years with outcomes available for analysis). Neurodevelopmental impairment at 18 to 26 months' corrected age (CA) was defined as a Bayley Scales of Infant and Toddler Development, Third Edition, cognitive composite score less than 85, a motor composite score less than 85, moderate or severe cerebral palsy, gross motor function classification system score of 2 or greater, bilateral blindness, and/or hearing impairment. Data were analyzed from September 2017 to October 2018.EXPOSURES Birth weight less than 400 g.MAIN OUTCOMES AND MEASURES The primary outcome was survival to discharge among infants who received active treatment. Analysis of follow-up data was limited to infants born from 2008 to 2015 to ensure children had reached assessment age. Within this cohort, neurodevelopmental outcomes were assessed for infants who survived to 18 to 26 months' CA and returned for a comprehensive visit.RESULTS Of the 205 included infants, 121(59.0%) were female, 133 (64.9%) were singletons, and 178 (86.8%) were small for gestational age. Almost half (101of 205 [49.3%]) received active treatment at birth. A total of 26 of 205 infants (12.7%; 95% CI, 8.5-18.9) overall survived to discharge, and 26 of 101 actively treated infants (25.7%; 95% CI, 17.6-35.4) survived to discharge. Within the subset of infants with a BW less than 400 g and a GA of 22 to 23 weeks, 6 of 36 actively treated infants (17%; 95% CI, 6-33) survived to discharge. Among infants born between 2008 and 2015, 23 of 90 actively treated infants (26%; 95% CI, 17-36) survived to discharge. Two infants died after discharge, and 2 were lost to follow-up. Thus, 19 of 90 actively treated infants (21%; 95% CI, 13-31) were evaluated at 18 to 26 months' CA. Moderate or severe NDI occurred in 14 of 19 infants (74%).CONCLUSIONS AND RELEVANCE Infants born with a BW less than 400 g are at high risk of mortality and significant morbidity. Although 21% of infants survived to 18 to 26 months' CA with active treatment, NDI was common among survivors.