Kono Yumi, Yonemoto Naohiro, Nakanishi Hidehiko, Kusuda Satoshi, Fujimura Masanori
Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan.
Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan.
BMJ Paediatr Open. 2018 Jan 20;2(1):e000211. doi: 10.1136/bmjpo-2017-000211. eCollection 2018.
To evaluate changes in the outcomes of infants born at <25 weeks' gestation in the past decade.
Retrospective observational study.
A multicentre database of the Neonatal Research Network, Japan.
A total of 3318 infants born at 22-24 weeks' gestation between periods 1 (2003-2007) and 2 (2008-2012) from 52 tertiary centres.
We compared death and neurodevelopmental impairments (NDIs) at 3 years of age, including cerebral palsy (CP), visual impairments (VIs), hearing impairments (HIs) and the developmental quotient (DQ) of the Kyoto Scale of Psychological Development test <70, between two periods using multivariate logistic regression analyses adjusted for the centre, gender, multiple gestation, maternal age, caesarean delivery, antenatal steroid use, pregnancy-related hypertension, clinical chorioamnionitis, congenital anomalies and birth weight.
A total of 496/1479 infants (34%) in period 1 and 467/1839 (25%) in period 2 died by 3 years of age (adjusted OR 0.70, 95% CIs 0.59 to 0.83). Follow-up data were collected from 631 infants (64% of survivors) in period 1 and 832 (61% of survivors) in period 2. The proportions of CP with Gross Motor Function Classification System ≥2, VI and HI in the infants evaluated were lower, while that of DQ <70 was higher in period 2 than in period 1. Using multiple imputations to account for missing data, death or NDI decreased from 54% in period 1 to 47% in period 2 (0.83, 0.71 to 0.97). Significant decreases were observed in death or CP (0.65, 0.55 to 0.76), death or VI (0.59, 0.50 to 0.69) and death or HI (0.69, 0.58 to 0.81), but not in death or DQ <70 (0.91, 0.78 to 1.06).
Along with improved survival, CP, VI and HI, but not cognitive impairments decreased in infants born at <25 weeks' gestation between the two periods examined in the last decade. Further strategies are needed to reduce cognitive impairments in these infants.
评估过去十年中孕龄小于25周出生的婴儿的结局变化。
回顾性观察研究。
日本新生儿研究网络的多中心数据库。
来自52个三级中心的共3318例在22 - 24周孕龄出生的婴儿，分为1期（2003 - 2007年）和2期（2008 - 2012年）。
我们使用多因素逻辑回归分析，对中心、性别、多胎妊娠、产妇年龄、剖宫产、产前使用类固醇、妊娠相关高血压、临床绒毛膜羊膜炎、先天性异常和出生体重进行校正，比较两期3岁时的死亡和神经发育障碍（NDI）情况，包括脑瘫（CP）、视力障碍（VI）、听力障碍（HI）以及京都心理发育量表发育商（DQ）<70的情况。
1期共496/1479例婴儿（34%）在3岁前死亡，2期为467/1839例（25%）（校正后比值比0.70，95%可信区间0.59至0.83）。收集了1期631例婴儿（占幸存者的64%）和2期832例婴儿（占幸存者的61%）的随访数据。在接受评估的婴儿中，粗大运动功能分类系统≥2级的CP、VI和HI的比例在2期低于1期，而DQ<70的比例在2期高于1期。使用多重填补法处理缺失数据后，死亡或NDI从1期的54%降至2期的47%（0.83，0.71至0.97）。死亡或CP（0.65，0.55至0.76）、死亡或VI（0.59，0.50至0.69）和死亡或HI（0.69，0.58至0.81）显著下降，但死亡或DQ<70无显著下降（0.91，0.78至1.06）。
在过去十年所研究的两个时期中，孕龄小于25周出生的婴儿在生存率提高的同时，CP、VI和HI有所减少，但认知障碍未减少。需要进一步采取策略来降低这些婴儿的认知障碍。
