Kobaly Kristen, Schluchter Mark, Minich Nori, Friedman Harriet, Taylor Hudson Gerry, Wilson-Costello Deanne, Hack Maureen
Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA.
Pediatrics. 2008 Jan;121(1):73-81. doi: 10.1542/peds.2007-1444.
The goal was to evaluate whether changes in neonatal intensive care have improved outcomes for children with bronchopulmonary dysplasia (oxygen dependence at corrected age of 36 weeks).
We compared outcomes of extremely low birth weight (<1 kg) and extremely low gestational age (<28 weeks) infants with bronchopulmonary dysplasia between 2 periods (period I, 1996-1999: extremely low birth weight, n = 122; extremely low gestational age, n = 118; period II, 2000-2003: extremely low birth weight, n = 109; extremely low gestational age, n = 107).
For both groups, significant practice changes between period I and period II included increased prenatal and decreased postnatal steroid therapy and increased surfactant therapy, indomethacin therapy, and patent ductus arteriosus ligation. Significant morbidity changes included decreased rates of severe cranial ultrasound abnormalities and increased rates of ventilator dependence. Rates of bronchopulmonary dysplasia did not change (52% vs 53%). Follow-up evaluation revealed significantly lower rates of neurosensory abnormalities during period II (extremely low birth weight: 29% vs 16%; extremely low gestational age: 31% vs 16%). There were no changes in rates of Mental Developmental Index scores of <70 (extremely low birth weight: 42% vs 42%; extremely low gestational age: 37% vs 45%) or overall developmental impairment (extremely low birth weight: 51% vs 49%; extremely low gestational age: 50% vs 51%). For the extremely low gestational age group, predictors of neurosensory abnormalities were severe cranial ultrasound abnormality and postnatal steroid therapy. Predictors of overall impairment included severe cranial ultrasound abnormalities, ventilator dependence, postnatal steroid therapy, and patent ductus arteriosus ligation. For the extremely low birth weight group, the only predictor of neurosensory abnormalities was severe cranial ultrasound abnormality. Predictors of overall impairment included multiple birth, ventilator dependence, and severe cranial ultrasound abnormalities.
Neurosensory outcomes of infants with bronchopulmonary dysplasia improved during 2000 to 2003 but overall neurodevelopmental outcomes did not change.
评估新生儿重症监护的变化是否改善了支气管肺发育不良患儿（矫正年龄36周时仍依赖氧气）的预后。
我们比较了两个时期（时期I，1996 - 1999年：极低出生体重儿，n = 122；极早早产儿，n = 118；时期II，2000 - 2003年：极低出生体重儿，n = 109；极早早产儿，n = 107）患有支气管肺发育不良的极低出生体重（<1 kg）和极早早产（<28周）婴儿的预后。
对于两组，时期I和时期II之间显著的实践变化包括产前类固醇治疗增加、产后类固醇治疗减少以及表面活性剂治疗、吲哚美辛治疗和动脉导管未闭结扎增加。显著的发病率变化包括严重颅脑超声异常率降低和呼吸机依赖率增加。支气管肺发育不良的发生率没有变化（52%对53%）。随访评估显示时期II期间神经感觉异常率显著降低（极低出生体重儿：29%对16%；极早早产儿：31%对16%）。智力发育指数评分<70的发生率（极低出生体重儿：42%对42%；极早早产儿：37%对45%）或总体发育障碍（极低出生体重儿：51%对49%；极早早产儿：50%对51%）没有变化。对于极早早产儿组，神经感觉异常的预测因素是严重颅脑超声异常和产后类固醇治疗。总体障碍的预测因素包括严重颅脑超声异常、呼吸机依赖、产后类固醇治疗和动脉导管未闭结扎。对于极低出生体重儿组，神经感觉异常的唯一预测因素是严重颅脑超声异常。总体障碍的预测因素包括多胎、呼吸机依赖和严重颅脑超声异常。
2000年至2003年期间，支气管肺发育不良婴儿的神经感觉预后有所改善，但总体神经发育预后没有变化。
