极低出生体重儿的预后改善：来自新西兰全国基于人群数据的证据。
Improved outcomes for very low birthweight infants: evidence from New Zealand national population based data.
作者信息
Darlow B A, Cust A E, Donoghue D A
机构信息
Department of Paediatrics, Christchurch School of Medicine, New Zealand.
出版信息
Arch Dis Child Fetal Neonatal Ed. 2003 Jan;88(1):F23-8. doi: 10.1136/fn.88.1.f23.
OBJECTIVE
To compare the survival and short term morbidity of all New Zealand very low birthweight (VLBW) infants born in two epochs, 1986 and 1998-1999.
SETTING
All level III and level II neonatal intensive care units (NICUs) in New Zealand.
METHODS
In 1986, data were prospectively collected for a study of retinopathy of prematurity (ROP). In 1998-1999, prospective data were collected by the Australian and New Zealand Neonatal Network (ANZNN). Both cohorts included all VLBW infants born during the calendar year and admitted to a NICU. Data were collected from birth until discharge home or death.
RESULTS
More VLBW infants were admitted for care in 1998-1999 (n = 1084, 0.96% of livebirths) than in 1986 (n = 413, 0.78% of livebirths; p < 0.001), including a higher proportion of VLBW infants of < 1000 g birth weight (38% v 32% respectively; p < 0.05). Survival to discharge home increased from 81.8% in 1986 to 90.3% in 1998-1999 (p < 0.001). The 1998-1999 cohort had a higher proportion of infants born in a hospital with a level III NICU (87% v 72% in 1986; p < 0.001) and receiving antenatal corticosteroids (80% v 58% in 1986; p < 0.001). In 1998-1999, the incidence of several morbidities had decreased compared with 1986, including oxygen dependency at 28 days (29% v 39% respectively; p = 0.001) and at 36 weeks postmenstrual age (16% v 23%; p = 0.002), grade 1 intraventricular haemorrhage (IVH) (8% v 24%; p < 0.001), grade 2/3 IVH (5% v 11%; p < 0.001), and stage 3/4 ROP for infants < 1000 g (6% v 13%; p < 0.001).
CONCLUSIONS
The outlook for VLBW infants in New Zealand has improved since 1986.
目的
比较1986年和1998 - 1999年这两个时期在新西兰出生的所有极低出生体重（VLBW）婴儿的存活率和短期发病率。
地点
新西兰所有三级和二级新生儿重症监护病房（NICU）。
方法
1986年，前瞻性收集数据用于早产儿视网膜病变（ROP）研究。1998 - 1999年，澳大利亚和新西兰新生儿网络（ANZNN）前瞻性收集数据。两个队列均包括当年出生并入住NICU的所有VLBW婴儿。收集从出生到出院回家或死亡的数据。
结果
1998 - 1999年接受护理的VLBW婴儿（n = 1084，占活产儿的0.96%）比1986年（n = 413，占活产儿的0.78%；p < 0.001）更多，包括出生体重<1000g的VLBW婴儿比例更高（分别为38%对32%；p < 0.05）。出院回家的存活率从1986年的81.8%提高到1998 - 1999年的90.3%（p < 0.001）。1998 - 1999年队列中，在设有三级NICU的医院出生的婴儿比例更高（1998 - 1999年为87%，1986年为72%；p < 0.001），接受产前皮质类固醇治疗的婴儿比例也更高（1998 - 1999年为80%，1986年为58%；p < 0.001）。1998 - 1999年，与1986年相比，几种疾病的发病率有所下降，包括28天时的氧依赖（分别为29%对39%；p = 0.001）和孕龄36周时的氧依赖（16%对23%；p = 0.002）、1级脑室内出血（IVH）（8%对24%；p < 0.001）、2/3级IVH（5%对11%；p < 0.001）以及出生体重<1000g婴儿的3/4期ROP（6%对13%；p < 0.001）。
结论
自1986年以来，新西兰VLBW婴儿的前景有所改善。
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