de Kleine Martin J K, den Ouden A Lya, Kollée Louis A A, Ilsen Adri, van Wassenaer Aleid G, Brand Ronald, Verloove-Vanhorick S Pauline
Department of Neonatology, Máxima Medical Centre, 5500 MD Veldhoven, The Netherlands.
Paediatr Perinat Epidemiol. 2007 Jan;21(1):15-25. doi: 10.1111/j.1365-3016.2007.00780.x.
Better perinatal care has led to better survival of very preterm children, but may or may not have increased the number of children with cerebral and pulmonary morbidity. We therefore investigated the relationship between changes in perinatal care during one decade, and short-term outcome in very preterm infants. Perinatal risk factors and their effects on 28-day and in-hospital mortality, and on intraventricular haemorrhage and bronchopulmonary dysplasia (BPD) in survivors, were compared in two surveys of very preterm singleton infants in the Netherlands. Between 1983 and 1993, 28-day mortality decreased from 52.1% to 31.8% in infants of 25-27 weeks' gestation and from 15.2% to 11.3% in infants of 28-31 weeks' gestation. The incidence of intraventricular haemorrhage in survivors did not change (44.4% and 43.3% in infants of 25-27 weeks' gestation, and 29.0% and 24.0% in infants of 28-31 weeks' gestation). The incidence of BPD in survivors increased from 40.3% to 60.0% in infants of 25-27 weeks' gestation and remained similar in infants of 28-31 weeks' gestation (8.5% and 9.8% respectively). In multivariable analysis, higher mortality was associated with congenital malformation, low gestational age, low birthweight, no administration of steroids before birth, low Apgar scores and intraventricular haemorrhage, in 1983 as well in 1993, and with male gender in 1993. The effect of maternal age on mortality diminished significantly between 1983 and 1993. Intraventricular haemorrhage in surviving children was associated with low gestational age and artificial ventilation, both in 1983 and in 1993. The effect of artificial ventilation on the incidence of intraventricular haemorrhage diminished significantly between 1983 and 1993. BPD was associated with low gestational age and artificial ventilation, both in 1983 and in 1993, and with low birthweight and caesarean section in 1993. We conclude that the better survival of very preterm infants, especially of those of 25-27 weeks' gestation, has been accompanied by a similar incidence (and thus with an increased absolute number) of children with intraventricular haemorrhage and by an increased incidence of children with BPD.
更好的围产期护理已使极早产儿的存活率提高，但可能并未增加患有脑和肺部疾病的儿童数量。因此，我们调查了十年间围产期护理的变化与极早产儿短期预后之间的关系。在荷兰对极早产单胎婴儿进行的两项调查中，比较了围产期危险因素及其对28天和住院死亡率以及对存活者脑室内出血和支气管肺发育不良（BPD）的影响。1983年至1993年间，孕25 - 27周婴儿的28天死亡率从52.1%降至31.8%，孕28 - 31周婴儿的死亡率从15.2%降至11.3%。存活者脑室内出血的发生率未发生变化（孕25 - 27周婴儿中分别为44.4%和43.3%，孕28 - 31周婴儿中分别为29.0%和24.0%）。孕25 - 27周婴儿存活者中BPD的发生率从40.3%增至60.0%，孕28 - 31周婴儿中的发生率保持相似（分别为8.5%和9.8%）。在多变量分析中，1983年和1993年，较高的死亡率均与先天性畸形、低孕周、低出生体重、出生前未使用类固醇、低阿氏评分和脑室内出血有关，1993年还与男性性别有关。1983年至1993年间，母亲年龄对死亡率的影响显著降低。1983年和1993年，存活儿童的脑室内出血均与低孕周和人工通气有关。1983年至1993年间，人工通气对脑室内出血发生率的影响显著降低。1983年和1993年，BPD均与低孕周和人工通气有关，1993年还与低出生体重和剖宫产有关。我们得出结论，极早产儿，尤其是孕25 - 27周的婴儿存活率提高的同时，脑室内出血患儿的发生率相似（因此绝对数量增加），且BPD患儿的发生率有所增加。
