Stephens Alexandre S, Lain Samantha J, Roberts Christine L, Bowen Jennifer R, Nassar Natasha
Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney, NSW, Australia.
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
Paediatr Perinat Epidemiol. 2016 Nov;30(6):583-593. doi: 10.1111/ppe.12323. Epub 2016 Oct 24.
Although infant and child mortality rates have decreased substantially worldwide over the past two decades, efforts continue in many nations to further these declines. The identification of pertinent perinatal factors that are associated with early childhood mortality would help with these efforts. We investigated the association of two crucial perinatal factors, gestational age and severe neonatal morbidity at birth, with mortality during infancy (29-364 days) and early childhood (1-5 years).
The study population included all singleton livebirths, ≥32 weeks' gestation in New South Wales, Australia in 2001-11. Birth data were linked to hospitalisation morbidity data and deaths data (linked birth cohort n = 871 916), and multivariable Cox regression models were used to assess mortality.
The median follow-up time per child was 4.95 years (range 0.00-5.92 years; 3 614 738 total person-years), with 984 deaths observed. Gestational age was associated with increased mortality, and specifically from deaths attributable to infections, respiratory conditions, and injuries during infancy, but not during early childhood. Severe neonatal morbidity strongly mediated the effects of gestational age during infancy, but not during early childhood, and was associated with increased mortality from circulatory, nervous, and respiratory system causes.
The direct effects of gestational age on mortality extended up to 1 year of age, whereas severe neonatal morbidity remained associated with heightened mortality into early childhood. Efforts to maximise the health and well-being of vulnerable infants, with emphasis on preventing infections and injuries, may help further reduce early childhood mortality.
尽管在过去二十年里全球婴幼儿死亡率大幅下降，但许多国家仍在继续努力进一步降低这一比率。确定与幼儿期死亡率相关的围产期相关因素将有助于这些努力。我们调查了两个关键围产期因素，即胎龄和出生时的严重新生儿疾病，与婴儿期（29 - 364天）和幼儿期（1 - 5岁）死亡率之间的关联。
研究人群包括2001 - 2011年在澳大利亚新南威尔士州所有孕周≥32周的单胎活产儿。出生数据与住院发病率数据和死亡数据相链接（链接出生队列n = 871916），并使用多变量Cox回归模型评估死亡率。
每个儿童的中位随访时间为4.95年（范围0.00 - 5.92年；总计3614738人年），观察到984例死亡。胎龄与死亡率增加相关，特别是与婴儿期因感染、呼吸系统疾病和损伤导致的死亡相关，但与幼儿期无关。严重新生儿疾病在婴儿期强烈介导了胎龄的影响，但在幼儿期没有，并且与循环、神经和呼吸系统原因导致的死亡率增加相关。
胎龄对死亡率的直接影响一直持续到1岁，而严重新生儿疾病在幼儿期仍与较高死亡率相关。努力使脆弱婴儿的健康和福祉最大化，重点是预防感染和损伤，可能有助于进一步降低幼儿期死亡率。
