Fanaroff Avroy A, Hack Maureen, Walsh Michele C
Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Semin Perinatol. 2003 Aug;27(4):281-7. doi: 10.1016/s0146-0005(03)00055-7.
The National Institute of Child Health and Human Development (NICHD) Neonatal Research Network was founded in 1986 to perform trials that, because of their size and complexity, were beyond the scope of a single center and required the expertise and resources of many collaborating centers. This report briefly documents changes in mortality, selected morbidities, and therapies amongst Network centers. The Network registry incorporating perinatal and neonatal data on all infants with a birth weight 501-1500 g cared for at participating centers served as the database. Mortality and selected morbidities were compared for 3 time periods, 1987/1988, (7 centers 1,765 infants, presurfactant); 1993/1994 (12 centers, 4,593 infants, postsurfactant and moderate antenatal corticosteroid utilization); and 1999/2000 (15 centers, 5,848 infants, postsurfactant and widespread corticosteroid use). Detailed outcomes for infants with birth weights between 501 and 800 g, and gestational ages of 23 to 25 weeks are also presented because they dramatically document the changes over time. Mortality for the entire cohort decreased from 23% in 1987/1988 to 17% in 1993/1994 and 14% in 1999/2000. Between 1987/1988 and 1999/2000 mortality prior to discharge, decreased from 66% to 45% for infants weighing 501-750 g; from 34% to 12% for birth weight between 751 to 1000 g, and from 13% to 7% for infants between 1001 and 1500 g. Mortality was higher in boys. Survival free of major morbidity (chronic lung disease/bronchopulmonary dysplasia, necrotizing enterocolitis or grade III/IV intraventricular hemorrhage) did not change significantly over time. Since the inception of the Network, multiple births have increased from 18% to 26%; deliveries by Cesarean section from 47% to 57%, and antenatal corticosteroid use increased from 16% to 79%. Surfactant, which was not used prior to 1990, is now given to 57% of the infants, including 87% with birth weights between 501 and 750 g. There have been significant decreases in the incidence of grade III-IV intraventricular hemorrhage from 18% in 1987/1988 to about 11% since 1993/1994, and periventricular leukomalacia from 8% to 3%. However, other morbidities, including necrotizing enterocolitis, patent ductus arteriosus, and late onset sepsis, have not changed substantially. Advances in perinatal care within NICHD Network centers have resulted in marked improvements in survival. Further advances are required to increase survival free of neonatal morbidity or neurodevelopmental impairment.
美国国立儿童健康与人类发展研究所（NICHD）新生儿研究网络成立于1986年，旨在开展一些因规模和复杂性超出单个中心范围、需要多个协作中心的专业知识和资源的试验。本报告简要记录了网络中心之间死亡率、特定发病率和治疗方法的变化。纳入参与中心所护理的所有出生体重在501 - 1500克婴儿围产期和新生儿数据的网络登记册用作数据库。对三个时间段的死亡率和特定发病率进行了比较，分别是1987/1988年（7个中心，1765名婴儿，使用表面活性剂前）；1993/1994年（12个中心，4593名婴儿，使用表面活性剂后且适度使用产前皮质类固醇）；以及1999/2000年（15个中心，5848名婴儿，使用表面活性剂后且广泛使用皮质类固醇）。还呈现了出生体重在501至800克、胎龄为23至25周婴儿的详细结局，因为它们显著记录了随时间的变化。整个队列的死亡率从1987/1988年的23%降至1993/1994年的17%以及1999/2000年的14%。在1987/1988年至1999/2000年期间，出院前死亡率方面，出生体重501 - 750克的婴儿从66%降至45%；出生体重751至1000克的婴儿从34%降至12%；出生体重1001至1500克的婴儿从13%降至7%。男孩的死亡率更高。无主要发病（慢性肺病/支气管肺发育不良、坏死性小肠结肠炎或III/IV级脑室内出血）的存活率随时间未发生显著变化。自网络成立以来，多胞胎从18%增加到26%；剖宫产率从47%增加到57%，产前皮质类固醇的使用从16%增加到79%。1990年前未使用的表面活性剂，现在57%的婴儿使用，包括87%出生体重在501至750克的婴儿。III - IV级脑室内出血的发生率从1987/1988年的18%显著下降至1993/1994年后的约11%，脑室周围白质软化从8%降至3%。然而，其他发病率，包括坏死性小肠结肠炎、动脉导管未闭和晚发性败血症，基本未变。NICHD网络中心围产期护理的进展已使存活率显著提高。还需要进一步进展以提高无新生儿发病或神经发育障碍的存活率。
