瑞士早产儿的13年死亡率和发病率
Thirteen-year mortality and morbidity in preterm infants in Switzerland.
作者信息
Chen Fei, Bajwa Nadia M, Rimensberger Peter C, Posfay-Barbe Klara M, Pfister Riccardo E
机构信息
Division of Neonatology and Paediatric Intensive Care, Children's University Hospital of Geneva and University of Geneva, Geneva, Switzerland Department of Child Health-Care, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China.
Department of Paediatrics, Children's University Hospital of Geneva and University of Geneva, Geneva, Switzerland.
出版信息
Arch Dis Child Fetal Neonatal Ed. 2016 Sep;101(5):F377-83. doi: 10.1136/archdischild-2015-308579. Epub 2016 Apr 8.
OBJECTIVE
To report the population-based, gestational age (GA)-stratified mortality and morbidity for very preterm infants over 13 years in Switzerland.
DESIGN
A prospective, observational study including 95% of Swiss preterm infants (GA <32 weeks) during three time periods: 2000-2004 (P1), 2005-2008 (P2) and 2009-2012 (P3).
SETTING
The Swiss Neonatal Network, covering all level III neonatal intensive care units (NICUs) and affiliated paediatric hospitals.
PATIENTS
8899 live-born preterm infants with GA <32 weeks.
MAIN OUTCOME MEASURES
Trends in GA-specific mortality (overall, delivery room and NICU), 'survival free of major complications' and major short-term morbidities: bronchopulmonary dysplasia (BPD, oxygen requirement at 36 weeks), grades 3 and 4 intraventricular haemorrhage (IVH 3-4), necrotising enterocolitis (NEC) and cystic periventricular leukomalacia (cPVL).
RESULTS
Survival rate was 84.4%; 5.7% died in the delivery room and 9.9% died in the NICU. Neonatal mortality was 8.6% and post-neonatal mortality in NICU admissions was 1.3%. Reductions were observed in overall mortality from 18.4% (95% CI 17.0% to 19.8%) in P1 to 13.8% (13% to 15%) in P3, NICU mortality from 12.6% (11.4% to 13.8%) to 8.2% (7.2% to 9.2%) and IVH 3-4 from 7.8% (6.8% to 8.7%) to 5.8% (4.9% to 6.6%). There was no change in the incidence of cPVL and NEC. The BPD (oxygen requirement at 36 weeks) incidence displayed a U-shaped distribution across the three time periods. Overall, 71.0% (70.0% to 72.0%) had 'survival free of major complications' at the time of hospital discharge, and this significantly improved from 66.7% (65.0% to 68.4%) to 72.4% (70.8% to 74.0%) between P1 and P3.
CONCLUSIONS
Survival rates of very preterm infants increased with decreasing delivery room and neonatal mortalities, mostly in extremely preterm infants. The incidence of IVH 3-4 decreased, whereas the incidences of cPVL, NEC and BPD (oxygen requirement at 36 weeks) remained largely unchanged from 2000 to 2012 in Switzerland.
目的
报告瑞士13年间基于人群的极早产儿按孕周（GA）分层的死亡率和发病率。
设计
一项前瞻性观察性研究，涵盖三个时间段（2000 - 2004年（P1）、2005 - 2008年（P2）和2009 - 2012年（P3））95%的瑞士早产儿（GA<32周）。
设置
瑞士新生儿网络，覆盖所有三级新生儿重症监护病房（NICU）及附属儿科医院。
患者
8899例GA<32周的活产早产儿。
主要观察指标
特定孕周死亡率（总体、产房和NICU）、“无重大并发症存活”情况以及主要短期发病率：支气管肺发育不良（BPD，36周时需氧）、3级和4级脑室内出血（IVH 3 - 4）、坏死性小肠结肠炎（NEC）和脑室周围白质软化症（cPVL）。
结果
存活率为84.4%；5.7%在产房死亡，9.9%在NICU死亡。新生儿死亡率为8.6%，NICU入院患儿的新生儿后期死亡率为1.3%。观察到总体死亡率从P1期的18.4%（95%CI 17.0%至19.8%）降至P3期的13.8%（13%至15%），NICU死亡率从12.6%（11.4%至13.8%）降至8.2%（7.2%至9.2%），IVH 3 - 4从7.8%（6.8%至8.7%）降至5.8%（4.9%至6.6%）。cPVL和NEC的发病率无变化。BPD（36周时需氧）发病率在三个时间段呈U形分布。总体而言，71.0%（70.0%至72.0%）在出院时“无重大并发症存活”，且这一比例在P1期和P3期之间从66.7%（65.0%至68.4%）显著提高至72.4%（70.8%至74.0%）。
结论
极早产儿存活率随产房和新生儿死亡率降低而提高，主要是极早早产儿。IVH 3 - 4发病率降低，而在瑞士，2000年至2012年期间cPVL、NEC和BPD（36周时需氧）的发病率基本保持不变。
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