Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, 2015 Uppergate Dr, Atlanta, GA 30322, USA.
Pediatrics. 2010 Sep;126(3):443-56. doi: 10.1542/peds.2009-2959. Epub 2010 Aug 23.
This report presents data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network on care of and morbidity and mortality rates for very low birth weight infants, according to gestational age (GA).
Perinatal/neonatal data were collected for 9575 infants of extremely low GA (22-28 weeks) and very low birth weight (401-1500 g) who were born at network centers between January 1, 2003, and December 31, 2007.
Rates of survival to discharge increased with increasing GA (6% at 22 weeks and 92% at 28 weeks); 1060 infants died at <or=12 hours, with most early deaths occurring at 22 and 23 weeks (85% and 43%, respectively). Rates of prenatal steroid use (13% and 53%, respectively), cesarean section (7% and 24%, respectively), and delivery room intubation (19% and 68%, respectively) increased markedly between 22 and 23 weeks. Infants at the lowest GAs were at greatest risk for morbidities. Overall, 93% had respiratory distress syndrome, 46% patent ductus arteriosus, 16% severe intraventricular hemorrhage, 11% necrotizing enterocolitis, and 36% late-onset sepsis. The new severity-based definition of bronchopulmonary dysplasia classified more infants as having bronchopulmonary dysplasia than did the traditional definition of supplemental oxygen use at 36 weeks (68%, compared with 42%). More than one-half of infants with extremely low GAs had undetermined retinopathy status at the time of discharge. Center differences in management and outcomes were identified.
Although the majority of infants with GAs of >or=24 weeks survive, high rates of morbidity among survivors continue to be observed.
本报告根据胎龄（GA）介绍了 Eunice Kennedy Shriver 国立儿童健康与人类发育研究所新生儿研究网络有关极低出生体重儿护理和发病率及死亡率的数据。
2003 年 1 月 1 日至 2007 年 12 月 31 日，在网络中心出生的极早产儿（GA22-28 周）和极低出生体重儿（401-1500g）的围产儿/新生儿数据被收集。
存活率随 GA 增加而增加（22 周时为 6%，28 周时为 92%）；<12 小时死亡的 1060 名婴儿中，大多数早期死亡发生在 22 周和 23 周（分别为 85%和 43%）。产前使用类固醇（分别为 13%和 53%）、剖宫产（分别为 7%和 24%）和产房插管（分别为 19%和 68%）在 22 至 23 周之间显著增加。GA 最低的婴儿患病风险最大。总体而言，93%患有呼吸窘迫综合征，46%患有动脉导管未闭，16%患有严重的脑室出血，11%患有坏死性小肠结肠炎，36%患有晚发性败血症。与传统的 36 周时使用补充氧气的定义相比，基于严重程度的新支气管肺发育不良定义将更多的婴儿归类为患有支气管肺发育不良（68%，42%）。出院时，超过一半的极早产儿的视网膜病变状况不确定。确定了中心之间在管理和结果方面的差异。
尽管大多数 GA>24 周的婴儿存活，但幸存者的高发病率仍在继续观察到。
