Fustiñana Carlos A, Izbizky Gustavo, Rodríguez Diana, Mariani Gonzalo, Ceriani Cernadas José M
Servicio de Neonatología, Departamento de Pediatría, Hospital Italiano, Buenos Aires.
Arch Argent Pediatr. 2009 Feb;107(1):9-15. doi: 10.1590/S0325-00752009000100005.
Although many therapeutic interventions have proven efficacy through randomized control trials (RCT) with extensive use in Neonatal Intensive Care Units (NICU) for Very Low Birth Weight Infants (VLBWI), doubts remain about its overall effectiveness.
To determine changes in the effectiveness of NICU practices on VLBWI over 14 years in the quality of neonatal survival in a General Hospital, with emphasis in the change in reanimation practices by the introduction of the spread use of surfactant.
We included all consecutive VLBWI admitted in our NICU during a period of 14 years: 1989-1992 (n= 145); 1993-2002 (n= 342). All survivors were included in our follow-up program; 80% and 85% were available for assessment at two years of corrected age. The patients were assigned to 4 groups by weight in 250 g categories, between 500 and 1500 g.
Survival and adjusted quality of survival (QS). The QS was expressed in life-years gained. We create categories for the estimation of disabilities. We also analyzed time of NICU stay by weight and mortality categories during the 2 periods.
The survival rate improved significantly between the 2 periods (23%) from 52% to 75%. The actuarial survival showed a significant increase in all weight groups (p <0.001), especially between 500-749 g (4% vs. 33%). The life-years gained showed differences in the BW <750 g (p <0.002, 3.6 vs. 23.4) y 750-999 g (p <0.001, 22.3 vs. 48); no differences were found in the others groups. The time of stay showed an increase of 30 days in the <750 g group (p <0.01) and decreased 8 days in the> or =1250 g group (p <0.01).
The effectiveness of neonatal intensive care for VLBWI improved in the period 1993-2002, after surfactant introduction, especially in the group <1000 g.
尽管许多治疗干预措施已通过随机对照试验（RCT）证明有效，并在新生儿重症监护病房（NICU）中广泛用于极低出生体重儿（VLBWI），但其总体有效性仍存在疑问。
确定一家综合医院14年来NICU对VLBWI的治疗措施在新生儿生存质量方面的有效性变化，重点关注因广泛使用表面活性剂而导致的复苏措施变化。
我们纳入了14年间在我们NICU收治的所有连续的VLBWI：1989 - 1992年（n = 145）；1993 - 2002年（n = 342）。所有幸存者均纳入我们的随访计划；校正年龄2岁时分别有80%和85%的患者可进行评估。根据体重以250 g为类别将患者分为4组，体重在500至1500 g之间。
生存率和校正后的生存质量（QS）。QS以获得的生命年数表示。我们创建了残疾评估类别。我们还分析了这两个时期按体重和死亡率类别划分的NICU住院时间。
两个时期之间的生存率显著提高（23%），从52%提高到75%。精算生存率在所有体重组中均显著增加（p <0.001），尤其是在500 - 749 g组（4%对33%）。获得的生命年数在体重<750 g组（p <0.002，3.6对23.4）和750 - 999 g组（p <0.001，22.3对48）存在差异；其他组未发现差异。住院时间在<750 g组增加了30天（p <0.01），在≥1250 g组减少了8天（p <0.01）。
在1993 - 2002年期间，引入表面活性剂后，NICU对VLBWI的治疗有效性得到改善，尤其是在<1000 g组。
