International Center on Birth Defects and Prematurity, Rome, Italy.
J Pediatr. 2013 Jun;162(6):1125-32, 1132.e1-4. doi: 10.1016/j.jpeds.2012.11.093. Epub 2013 Jan 18.
To assess the relationship between antenatal factors and cause-specific risk of death in a large area-based cohort of very preterm infants.
The ACTION (Accesso alle Cure e Terapie Intensive Ostetriche e Neonatali) study recruited during an 18-month period all infants 22-31 weeks' gestational age admitted to neonatal care in 6 Italian regions (n=3040). We analyzed the data of 2974 babies without lethal or acutely life-threatening malformations. Cause-specific risks of death adjusted for competing causes were calculated, and region-stratified multiple Cox regression analyses were used to study the association between cause-specific mortality and infants' characteristics, pregnancy complications, antenatal steroids, and place of birth.
Deaths attributable to respiratory problems and intraventricular hemorrhage prevailed in the first 2 weeks of life, and those attributable to infections and gastrointestinal diseases afterwards. Antepartum hemorrhage was associated with respiratory deaths (hazard ratio [HR] 1.6, 95% CI 1.1-2.4), and maternal infection with deaths attributable to asphyxia (HR 32.5, 95% CI 4.1-259.4) and to respiratory problems (HR 2.8, 95% CI 1.6-5.2). Preterm premature rupture of membranes increased the likelihood of deaths due to neonatal infection (HR 1.8, 95% CI 1.0-3.1), and preterm labor/contractions of those due to respiratory (HR 1.5, 95% CI 1.1-2.0) and gastrointestinal diseases (HR 5.8, 95% CI 2.1-16.3). In addition, a birth weight z-score<-1 was associated with increasing hazards of death resulting from asphyxia, late infections, respiratory, and gastrointestinal diseases.
Different complications of pregnancy lead to different cause-specific mortality patterns in very preterm infants.
在一项基于大型区域的极早产儿队列中，评估产前因素与特定病因死亡风险之间的关系。
ACTION（Accesso alle Cure e Terapie Intensive Ostetriche e Neonatali）研究在 18 个月期间招募了意大利 6 个地区所有 22-31 周胎龄新生儿重症监护入院的婴儿（n=3040）。我们分析了 2974 名无致死性或急性生命威胁性畸形的婴儿数据。针对竞争原因调整了特定病因死亡的风险，并使用区域分层多 Cox 回归分析研究了特定病因死亡率与婴儿特征、妊娠并发症、产前类固醇和分娩地点之间的关系。
在生命的前 2 周，呼吸问题和脑室内出血是导致死亡的主要原因，之后是感染和胃肠道疾病。产前出血与呼吸死亡有关（危险比[HR] 1.6，95%置信区间 1.1-2.4），母亲感染与窒息死亡（HR 32.5，95%置信区间 4.1-259.4）和呼吸问题（HR 2.8，95%置信区间 1.6-5.2）有关。胎膜早破增加了新生儿感染死亡的可能性（HR 1.8，95%置信区间 1.0-3.1），早产和宫缩增加了呼吸（HR 1.5，95%置信区间 1.1-2.0）和胃肠道疾病（HR 5.8，95%置信区间 2.1-16.3）的死亡风险。此外，体重 z 评分<-1 与窒息、晚期感染、呼吸和胃肠道疾病导致的死亡风险增加有关。
不同的妊娠并发症导致极早产儿不同的特定病因死亡模式。
