Chen Fei, Bajwa Nadia M, Rimensberger Peter C, Posfay-Barbe Klara M, Pfister Riccardo E
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.
Arch Dis Child Fetal Neonatal Ed. 2016 Sep;101(5):F377-83. doi: 10.1136/archdischild-2015-308579. Epub 2016 Apr 8.
To report the population-based, gestational age (GA)-stratified mortality and morbidity for very preterm infants over 13 years in Switzerland.
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).
The Swiss Neonatal Network, covering all level III neonatal intensive care units (NICUs) and affiliated paediatric hospitals.
8899 live-born preterm infants with GA <32 weeks.
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).
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.
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.
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。
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）。
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。
8899例GA<32周的活产早产儿。
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）。
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%）。
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。
