Hack M, Horbar J D, Malloy M H, Tyson J E, Wright E, Wright L
National Institute of Child Health and Human Development, Bethesda, MD.
Pediatrics. 1991 May;87(5):587-97.
This report describes the neonatal outcomes of 1765 very low birth weight (less than 1500 g) infants delivered from November 1987 through October 1988 at the seven participating centers of the National Institute of Child Health and Human Development Neonatal Intensive Care Network. Survival was 34% at less than 751 g birth weight (range between centers 20% to 55%), 66% at 751 through 1000 g (range 42% to 75%), 87% at 1001 through 1250 g (range 84% to 91%), and 93% at 1251 through 1500 g (range 89% to 98%). By obstetric measures of gestation, survival was 23% at 23 weeks (range 0% to 33%), 34% at 24 weeks (range 10% to 57%), and 54% at 25 weeks (range 30% to 72%). Neonatal morbidity included respiratory distress (67%), symptomatic patent ductus arteriosus (25%), necrotizing enterocolitis (6%), septicemia (17%), meningitis (2%), urinary tract infection (4%), and intraventricular hemorrhage (45%, 18% grade III and IV). Morbidity increased with decreasing birth weight. Oxygen was administered for greater than or equal to 28 days to 79% of less than 751-g birth weight infants (range between centers 67% to 100%), 45% of 751- through 1000-g infants (range 20% to 68%), and 13% of 1001- through 1500-g infants (range 5% to 23%). Ventilator support for greater than or equal to 28 days was given to 68% of infants at less than 751 g, 29% at 751 through 1000 g, and 4% at greater than 1000 g. Hospital stay was 59 days for survivors vs 15 days for infants who died. Sixty-nine percent of survivors had subnormal (less than 10th percentile) weight at discharge. The data demonstrate important intercenter variation of current neonatal outcomes, as well as differences in philosophy of care and definition and prevalence of morbidity.
本报告描述了1987年11月至1988年10月期间，在美国国立儿童健康与人类发展研究所新生儿重症监护网络的7个参与中心出生的1765例极低出生体重（小于1500克）婴儿的新生儿结局。出生体重小于751克的婴儿存活率为34%（各中心范围为20%至55%），751至1000克的婴儿存活率为66%（范围为42%至75%），1001至1250克的婴儿存活率为87%（范围为84%至91%），1251至1500克的婴儿存活率为93%（范围为89%至98%）。根据产科孕周测量，23周时存活率为23%（范围为0%至33%），24周时为34%（范围为10%至57%），25周时为54%（范围为30%至72%）。新生儿发病率包括呼吸窘迫（67%）、有症状的动脉导管未闭（25%）、坏死性小肠结肠炎（6%）、败血症（17%）、脑膜炎（2%）、尿路感染（4%）和脑室内出血（45%，其中18%为III级和IV级）。发病率随出生体重降低而增加。出生体重小于751克的婴儿中，79%接受了大于或等于28天的吸氧治疗（各中心范围为67%至100%），751至1000克的婴儿中45%接受了该治疗（范围为20%至68%），1001至1500克的婴儿中13%接受了该治疗（范围为5%至23%）。大于或等于28天的呼吸机支持应用于小于751克的婴儿中的68%，751至1000克的婴儿中的29%，以及大于1000克的婴儿中的4%。存活者的住院时间为59天，死亡婴儿为15天。69%的存活者出院时体重低于正常（低于第10百分位数）。数据显示了当前新生儿结局在各中心之间的重要差异，以及护理理念、发病率定义和患病率的差异。
