Department of Pediatrics, University of Manitoba, Canada.
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
J Pediatr. 2018 May;196:31-37.e1. doi: 10.1016/j.jpeds.2017.11.038. Epub 2018 Jan 3.
To compare mortality and neurodevelopmental outcomes of outborn and inborn preterm infants born at <29 weeks of gestation admitted to Canadian neonatal intensive care units (NICUs).
Data were obtained from the Canadian Neonatal Network and Canadian Neonatal Follow-up Network databases for infants born at <29 weeks of gestation admitted to NICUs from April 2009 to September 2011. Rates of death, severe neurodevelopmental impairment (NDI), and overall NDI were compared between outborn and inborn infants at 18-21 months of age, corrected for prematurity.
Of 2951 eligible infants, 473 (16%) were outborn. Mean birth weight (940 ± 278 g vs 897 + 237 g), rates of treatment with antenatal steroids (53.9% vs 92.9%), birth weight small for gestational age (5.3% vs 9.4%), and maternal college education (43.7% vs 53.9%) differed between outborn and inborn infants, respectively (all P values <.01). The median Score for Neonatal Acute Physiology-II (P = .01) and Apgar score at 5 minutes (P < .01) were higher in inborn infants. Severe brain injury was more common among outborn infants (25.3% vs 14.7%, P < .01). Outborn infants had higher odds of death or severe NDI (aOR 1.7, 95% CI 1.3-2.2), death or overall NDI (aOR 1.6, 95% CI 1.2-2.2), death (aOR 2.1, 95% CI 1.5-3.0), and cerebral palsy (aOR 1.9, 95% CI 1.1-3.3).
The composite outcomes of death or neurodevelopmental impairment were significantly higher in outborn compared with inborn infants admitted to Canadian NICUs. Adverse outcomes were mainly attributed to increased mortality and cerebral palsy in outborn neonates.
比较加拿大新生儿重症监护病房（NICU）收治的 29 周以下早产儿中，经阴道分娩儿与经剖宫产分娩儿的病死率和神经发育结局。
数据来自 2009 年 4 月至 2011 年 9 月加拿大新生儿网络和加拿大新生儿随访网络数据库，纳入 29 周以下入住 NICU 的患儿。对校正胎龄后 18-21 个月时的病死率、严重神经发育障碍（NDI）率和总 NDI 率进行经阴道分娩儿与剖宫产分娩儿之间的比较。
符合条件的 2951 例患儿中，473 例（16%）为经阴道分娩儿。经阴道分娩儿的平均出生体重（940±278g 比 897±237g）、产前使用类固醇的比例（53.9%比 92.9%）、小于胎龄儿的比例（5.3%比 9.4%）和母亲受过大学教育的比例（43.7%比 53.9%）分别有差异（均 P<0.01）。经阴道分娩儿的新生儿急性生理学评分Ⅱ中位数（P=0.01）和 5 分钟时的 Apgar 评分（P<0.01）均较高。经阴道分娩儿的严重脑损伤更为常见（25.3%比 14.7%，P<0.01）。经阴道分娩儿发生死亡或严重 NDI 的风险更高（校正比值比[aOR]1.7，95%可信区间[CI]1.3-2.2）、死亡或总 NDI（aOR 1.6，95% CI 1.2-2.2）、死亡（aOR 2.1，95% CI 1.5-3.0）和脑瘫（aOR 1.9，95% CI 1.1-3.3）的风险也更高。
与经剖宫产分娩儿相比，加拿大 NICU 收治的经阴道分娩儿的死亡或神经发育障碍复合结局显著更高。不良结局主要归因于经阴道分娩儿的死亡率和脑瘫发生率较高。
