Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Arch Dis Child Fetal Neonatal Ed. 2019 Jan;104(1):F36-F45. doi: 10.1136/archdischild-2017-313697. Epub 2018 Jan 20.
To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates.
Area-based cohort study of all births before 32 weeks of gestational age.
16 regions in 11 European countries in 2011/2012.
Survivors to discharge from neonatal care (n=6422).
Severe neonatal morbidity was defined as intraventricular haemorrhage grades III and IV, cystic periventricular leukomalacia, surgical necrotizing enterocolitis and retinopathy of prematurity grades ≥3. A secondary outcome included severe bronchopulmonary dysplasia (BPD), data available in 14 regions. Common definitions for neonatal morbidities were established before data abstraction from medical records. Regional severe neonatal morbidity rates were correlated with regional in-hospital mortality rates for live births after adjustment on maternal and neonatal characteristics.
10.6% of survivors had a severe neonatal morbidity without severe BPD (regional range 6.4%-23.5%) and 13.8% including severe BPD (regional range 10.0%-23.5%). Adjusted inhospital mortality was 13.7% (regional range 8.4%-18.8%). Differences between regions remained significant after consideration of maternal and neonatal characteristics (P<0.001) and severe neonatal morbidity rates were not correlated with mortality rates (P=0.50).
Severe neonatal morbidity rates for VPT survivors varied widely across European regions and were independent of mortality rates.
调查欧洲不同地区极早产儿（VPT）严重新生儿发病率的变化情况，以及发病率是否在死亡率较低的地区高于死亡率较高的地区。
基于区域的所有 32 孕周前出生儿队列研究。
2011/2012 年 11 个欧洲国家的 16 个地区。
新生儿护理出院存活儿（n=6422）。
严重新生儿发病率定义为脑室出血 3 级和 4 级、囊性室管膜下脑白质软化、手术坏死性小肠结肠炎和早产儿视网膜病变 3 级及以上。次要结局包括严重支气管肺发育不良（BPD），14 个地区有相关数据。新生儿发病率的常见定义在从病历中提取数据之前已经建立。在调整了母亲和新生儿特征后，将区域严重新生儿发病率与活产儿院内死亡率相关联。
无严重 BPD 的幸存者中有 10.6%（区域范围 6.4%-23.5%）存在严重新生儿发病率，包括严重 BPD 的幸存者中有 13.8%（区域范围 10.0%-23.5%）。调整后的院内死亡率为 13.7%（区域范围 8.4%-18.8%）。考虑到母亲和新生儿特征后，区域间差异仍然显著（P<0.001），严重新生儿发病率与死亡率之间无相关性（P=0.50）。
VPT 幸存者的严重新生儿发病率在欧洲各地区差异很大，与死亡率无关。
