Chard T, Penney G, Chalmers J
Department of Obstetrics & Gynaecology, Reproductive Physiology Laboratory, St. Bartholomew's and The Royal London School of Medicine and Dentistry, St. Bartholomew's Hospital, West Smithfield, EC1A 7BE, London, UK.
Eur J Obstet Gynecol Reprod Biol. 2001 Mar;95(1):114-8. doi: 10.1016/s0301-2115(00)00366-3.
To determine the risk of neonatal death (NND) in relation to birth weight for gestational age and the presence or absence of maternal hypertensive disease in preterm neonates.
Record linkage of maternity data and neonatal mortality data.
Scotland, UK.
A group of 6946 live singleton preterm neonates without lethal congenital abnormalities born at 24-32 weeks between 1986 and 1992 inclusive. This group included 1448 cases of maternal hypertensive disease and 850 neonatal deaths.
Neonatal death.
The median birth weight for each gestational week was estimated from a fitted curve and each birth weight was recalculated as a multiple of the relevant median. The frequency of NND was much higher at lower gestations (73% at 24 weeks down to 2% at 32 weeks). Though the overall frequency of NND was lower in cases with hypertensive disease (8.6% versus 13.2%) this can be attributed to the fact that there were relatively fewer hypertensive cases in the high risk group at 24-27 weeks. In the 5498 cases not associated with maternal hypertensive disease, there were 726 NNDs. The mean MoM of birthweight for these NNDs was 0.982 (95% CI 0.967-0.996); this was only marginally different from the population mean (0.998; 95% CI 0.993-1.004). In the 1448 cases with maternal hypertensive disease, there were 124 NNDs. The overall birthweight for gestational age in the hypertensive group was substantially less than that of the whole population (mean MoM 0.84; 95% CI 0.83-0.85) and that of the 124 NNDs was still lower (mean MoM 0.75; 95% CI 0.724-0.782). For both hypertensive and non-hypertensive cases, inspection of the data categorised into deciles showed that there was a continuous increase in the frequency of NND throughout the weight range, being lowest for the heaviest babies and highest for those in the lower centiles.
(1) There is a relationship between birthweight for gestational age and risk of NND in infants born at 24-32 weeks; (2) this relationship is a continuum throughout the whole range of birthweight, not focused exclusively on a group defined as SGA; (3) provided appropriate birthweight standards are used, there is no extra effect on mortality from maternal hypertensive disease.
确定与胎龄出生体重以及早产新生儿是否存在母亲高血压疾病相关的新生儿死亡（NND）风险。
产妇数据与新生儿死亡率数据的记录链接。
英国苏格兰。
一组6946名单胎存活早产新生儿，于1986年至1992年（含）期间在24 - 32周出生，无致命先天性异常。该组包括1448例母亲高血压疾病病例和850例新生儿死亡病例。
新生儿死亡。
根据拟合曲线估计每个孕周的出生体重中位数，并将每个出生体重重新计算为相关中位数的倍数。NND的发生率在较低孕周时要高得多（24周时为73%，降至32周时为2%）。虽然母亲患有高血压疾病的病例中NND的总体发生率较低（8.6%对13.2%），但这可归因于24 - 27周高危组中高血压病例相对较少这一事实。在5498例与母亲高血压疾病无关的病例中，有726例NND。这些NND的出生体重中位数倍数（MoM）为0.982（95%可信区间0.967 - 0.996）；这与总体均值（0.998；95%可信区间0.993 - 1.004）仅略有不同。在1448例母亲患有高血压疾病的病例中，有124例NND。高血压组的胎龄出生体重总体上明显低于整个人群（平均MoM 0.84；95%可信区间0.83 - 0.85），而124例NND的出生体重更低（平均MoM 0.75；95%可信区间0.724 - 0.782）。对于高血压和非高血压病例，检查按十分位数分类的数据表明，在整个体重范围内NND的发生率持续上升，最重的婴儿发生率最低，百分位数较低的婴儿发生率最高。
（1）24 - 32周出生婴儿的胎龄出生体重与NND风险之间存在关联；（2）这种关联在整个出生体重范围内是连续的，并非仅集中在定义为小于胎龄儿（SGA）的群体；（3）若采用适当的出生体重标准，母亲高血压疾病对死亡率无额外影响。
