Srinivasjois Ravisha, Nembhard Wendy, Wong Kingsley, Bourke Jenny, Pereira Gavin, Leonard Helen
Department of Neonatology and Paediatrics, Joondalup Health Campus, Perth, Western Australia; School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.
Department of Epidemiology, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, AR; Telethon Kids Institute, Perth, Australia.
J Pediatr. 2017 Nov;190:185-191.e1. doi: 10.1016/j.jpeds.2017.07.051.
To quantify the independent risks of neonatal (0-28 days), postneonatal (29-364 days), 1- to 5- and 6- to 30-year mortality by gestational age and investigate changes in survival over time in an Australian birth cohort.
Maternal and birth related Western Australian population data (1980-2010) were linked to the state mortality data using a retrospective cohort study design involving 722 399 live-born singletons infants.
When compared with 39- to 41-week born infants, the adjusted risk ratio for neonatal mortality was 124.8 (95% CI 102.9-151.3) for 24-31 weeks of gestation, 3.4 (95% CI 2.4-4.7) for 35-36 weeks of gestation, and 1.4 (95% CI 1.1-1.8) for 37-38 weeks of gestation. For 24-31 weeks of gestation infants, the adjusted hazard ratio for postneonatal mortality (29-364 days) was 13.9 (95% CI 10.9-17.6), for 1- to 5-year mortality 1.4 (95% CI 0.7-3.0) and for 6- to 30-year mortality 1.3 (95% CI 0.8-2.3). The risk of neonatal and postneonatal mortality for those born preterm decreased over time.
In Western Australia, late preterm and early term infants experienced higher risk of neonatal and postneonatal mortality when compared with their full-term peers. There was insufficient evidence to show that gestational length was independently associated with mortality beyond 1 year of age. Neonatal and postneonatal mortality improved with each decade of the study period.
按胎龄量化新生儿期（0 - 28天）、新生儿后期（29 - 364天）、1至5岁以及6至30岁死亡率的独立风险，并调查澳大利亚一个出生队列中随时间推移的生存变化情况。
采用回顾性队列研究设计，将西澳大利亚州与孕产妇和出生相关的人口数据（1980 - 2010年）与该州的死亡率数据相链接，涉及722399名单胎活产婴儿。
与孕39至41周出生的婴儿相比，孕24至31周出生婴儿的新生儿期死亡调整风险比为124.8（95%置信区间102.9 - 151.3），孕35至36周出生婴儿为3.4（95%置信区间2.4 - 4.7），孕37至38周出生婴儿为1.4（95%置信区间1.1 - 1.8）。对于孕24至31周出生的婴儿，新生儿后期（29 - 364天）死亡调整风险比为13.9（95%置信区间10.9 - 17.6），1至5岁死亡风险比为1.4（95%置信区间0.7 - 3.0），6至30岁死亡风险比为1.3（95%置信区间0.8 - 2.3）。早产婴儿的新生儿期和新生儿后期死亡风险随时间下降。
在西澳大利亚州，晚期早产儿和早期足月儿与其足月同龄人相比，经历新生儿期和新生儿后期死亡的风险更高。没有足够证据表明胎龄与1岁以后的死亡率独立相关。在研究期间的每十年中，新生儿期和新生儿后期死亡率均有所改善。
