Griffin I J, Lee H C, Profit J, Tancedi D J
Department of Pediatrics, University of California-Davis, UCD Medical Center, Sacramento, CA, USA.
1] Department of Pediatrics, Stanford University, Stanford, CA, USA [2] The California Perinatal Quality Care Collaborative, Stanford, CA, USA.
J Perinatol. 2015 Jul;35(7):503-10. doi: 10.1038/jp.2014.233. Epub 2015 Jan 15.
Survival of preterm and very low birth weight (VLBW) infants has steadily improved. However, the rates of mortality and morbidity among the very smallest infants are poorly characterized.
Data from the California Perinatal Quality Care Collaborative for the years 2005 to 2012 were used to compare the mortality and morbidity of profoundly low birth weight (ProLBW, birth weight 300 to 500 g) and profoundly small for gestational age (ProSGA, <1st centile for weight-for-age) infants with very low birth weight (VLBW, birth weight 500 to 1500 g) and appropriate for gestational age (AGA, 5th to 95th centile for weight-for-age) infants, respectively.
Data were available for 44 561 neonates of birth weight <1500 g. Of these, 1824 were ProLBW and 648 were ProSGA. ProLBW and ProSGA differed in their antenatal risk factors from the comparison groups and were less likely to receive antenatal steroids or to be delivered by cesarean section. Only 14% of ProSGA and 21% of ProLBW infants survived to hospital discharge, compared with >80% of AGA and VLBW infants. The largest increase in mortality in ProSGA and ProLBW infants occurred prior to 12 h of age, and most mortality happened in this time period. Survival of the ProLBW and ProSGA infants was positively associated with higher gestational age, receipt of antenatal steroids, cesarean section delivery and singleton birth.
Survival of ProLBW and ProSGA infants is uncommon, and survival without substantial morbidity is rare. Survival is positively associated with receipt of antenatal steroids and cesarean delivery.
早产及极低出生体重（VLBW）婴儿的存活率已稳步提高。然而，极小婴儿的死亡率和发病率情况却鲜有描述。
利用2005年至2012年加利福尼亚围产期质量保健协作组的数据，分别比较极低位出生体重（ProLBW，出生体重300至500克）和极小于胎龄（ProSGA，体重低于同龄儿第1百分位数）婴儿与极低出生体重（VLBW，出生体重500至1500克）和适于胎龄（AGA，体重处于同龄儿第5至95百分位数）婴儿的死亡率和发病率。
有44561例出生体重<1500克的新生儿的数据。其中，1824例为ProLBW，648例为ProSGA。ProLBW和ProSGA与对照组在产前危险因素方面存在差异，接受产前类固醇治疗或剖宫产的可能性较小。ProSGA婴儿中只有14%、ProLBW婴儿中只有21%存活至出院，而AGA和VLBW婴儿的这一比例超过80%。ProSGA和ProLBW婴儿死亡率的最大增幅出现在出生后12小时之前，且大多数死亡发生在这一时间段。ProLBW和ProSGA婴儿的存活与较高的孕周、接受产前类固醇治疗、剖宫产分娩及单胎出生呈正相关。
ProLBW和ProSGA婴儿存活的情况并不常见，无严重疾病的存活情况则更为罕见。存活与接受产前类固醇治疗及剖宫产呈正相关。
