超早产儿的生存及神经发育结局
Survival and Neurodevelopmental Outcomes among Periviable Infants.
作者信息
Younge Noelle, Goldstein Ricki F, Bann Carla M, Hintz Susan R, Patel Ravi M, Smith P Brian, Bell Edward F, Rysavy Matthew A, Duncan Andrea F, Vohr Betty R, Das Abhik, Goldberg Ronald N, Higgins Rosemary D, Cotten C Michael
机构信息
From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.).
出版信息
N Engl J Med. 2017 Feb 16;376(7):617-628. doi: 10.1056/NEJMoa1605566.
BACKGROUND
Data reported during the past 5 years indicate that rates of survival have increased among infants born at the borderline of viability, but less is known about how increased rates of survival among these infants relate to early childhood neurodevelopmental outcomes.
METHODS
We compared survival and neurodevelopmental outcomes among infants born at 22 to 24 weeks of gestation, as assessed at 18 to 22 months of corrected age, across three consecutive birth-year epochs (2000-2003 [epoch 1], 2004-2007 [epoch 2], and 2008-2011 [epoch 3]). The infants were born at 11 centers that participated in the National Institute of Child Health and Human Development Neonatal Research Network. The primary outcome measure was a three-level outcome - survival without neurodevelopmental impairment, survival with neurodevelopmental impairment, or death. After accounting for differences in infant characteristics, including birth center, we used multinomial generalized logit models to compare the relative risk of survival without neurodevelopmental impairment, survival with neurodevelopmental impairment, and death.
RESULTS
Data on the primary outcome were available for 4274 of 4458 infants (96%) born at the 11 centers. The percentage of infants who survived increased from 30% (424 of 1391 infants) in epoch 1 to 36% (487 of 1348 infants) in epoch 3 (P<0.001). The percentage of infants who survived without neurodevelopmental impairment increased from 16% (217 of 1391) in epoch 1 to 20% (276 of 1348) in epoch 3 (P=0.001), whereas the percentage of infants who survived with neurodevelopmental impairment did not change significantly (15% [207 of 1391] in epoch 1 and 16% [211 of 1348] in epoch 3, P=0.29). After adjustment for changes in the baseline characteristics of the infants over time, both the rate of survival with neurodevelopmental impairment (as compared with death) and the rate of survival without neurodevelopmental impairment (as compared with death) increased over time (adjusted relative risks, 1.27 [95% confidence interval {CI}, 1.01 to 1.59] and 1.59 [95% CI, 1.28 to 1.99], respectively).
CONCLUSIONS
The rate of survival without neurodevelopmental impairment increased between 2000 and 2011 in this large cohort of periviable infants. (Funded by the National Institutes of Health and others; ClinicalTrials.gov numbers, NCT00063063 and NCT00009633 .).
背景
过去5年报告的数据表明，处于存活临界状态的出生婴儿的存活率有所提高，但对于这些婴儿存活率的提高与幼儿神经发育结局之间的关系，人们了解得较少。
方法
我们比较了妊娠22至24周出生的婴儿在矫正年龄18至22个月时的存活率和神经发育结局，这些婴儿来自三个连续的出生年份时期（2000 - 2003年[时期1]、2004 - 2007年[时期2]和2008 - 2011年[时期3]）。这些婴儿出生于11个参与美国国立儿童健康与人类发展研究所新生儿研究网络的中心。主要结局指标是一个三级结局——无神经发育障碍存活、有神经发育障碍存活或死亡。在考虑了婴儿特征（包括出生中心）的差异后，我们使用多项广义对数模型来比较无神经发育障碍存活、有神经发育障碍存活和死亡的相对风险。
结果
在11个中心出生的4458名婴儿中，有4274名（96%）可获得主要结局的数据。存活婴儿的百分比从时期1的30%（1391名婴儿中的424名）增加到时期3的36%（1348名婴儿中的487名）（P<0.001）。无神经发育障碍存活的婴儿百分比从时期1的16%（1391名中的217名）增加到时期3的20%（1348名中的276名）（P = 0.001），而有神经发育障碍存活的婴儿百分比没有显著变化（时期1为15%[1391名中的207名]，时期3为16%[1348名中的211名]，P = 0.29）。在对婴儿基线特征随时间的变化进行调整后，有神经发育障碍存活（与死亡相比）和无神经发育障碍存活（与死亡相比）的比率均随时间增加（调整后的相对风险分别为1.27[95%置信区间{CI}，1.01至1.59]和1.59[95%CI，1.28至1.99]）。
结论
在这个大量的近存活婴儿队列中，2000年至2011年期间无神经发育障碍存活的比率有所增加。（由美国国立卫生研究院及其他机构资助；ClinicalTrials.gov编号，NCT00063063和NCT00009633。）
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