Departments of Paediatrics and Child Health and
Capital and Coast District Health Board, Wellington, New Zealand; and.
Pediatrics. 2018 Nov;142(5). doi: 10.1542/peds.2018-1016.
As outcomes for extremely premature infants improve, up-to-date, large-scale studies are needed to provide accurate, contemporary information for clinicians, families, and policy makers. We used nationwide New Zealand data to explore the impact of gestational age on health and educational outcomes through to adolescence.
We performed a retrospective cohort study of all births in New Zealand appearing in 2 independent national data sets at 23 weeks' gestation or more. We report on 2 separate cohorts: cohort 1, born January 1, 2005 to December 31, 2015 (613 521 individuals), used to study survival and midterm health and educational outcomes; and cohort 2, born January 1, 1998 to December 31, 2000, and surviving to age 15 years (146 169 individuals), used to study high school educational outcomes. Outcomes described by gestational age include survival, hospitalization rates, national well-being assessment outcomes at age 4 years, rates of special education support needs in primary school, and national high school examination results.
Ten-year survival increased with gestational age from 66% at 23 to 24 weeks to >99% at term. All outcomes measured were strongly related to gestational age. However, most extremely preterm children did not require special educational support and were able to sit for their national high school examinations.
Within a publicly funded health system, high-quality survival is achievable for most infants born at periviable gestations. Outcomes show improvement with gestational ages to term. Outcomes at early-term gestation are poorer than for children born at full term.
随着极早产儿存活率的提高，需要进行最新的大规模研究，为临床医生、家庭和决策者提供准确的当代信息。我们利用新西兰全国性数据，通过探索胎龄对健康和教育结果的影响，来了解青春期的情况。
我们对新西兰的所有在 23 孕周或以上的独立国家数据集中出现的分娩进行了回顾性队列研究。我们报告了两个独立的队列：队列 1，出生于 2005 年 1 月 1 日至 2015 年 12 月 31 日（613521 人），用于研究生存和中期健康及教育结果；队列 2，出生于 1998 年 1 月 1 日至 2000 年 12 月 31 日，且存活至 15 岁（146169 人），用于研究高中教育结果。根据胎龄描述的结果包括存活率、住院率、4 岁时全国幸福感评估结果、小学特殊教育支持需求率以及全国高中考试成绩。
10 年存活率随胎龄增加而增加，从 23-24 周的 66%增加到足月的>99%。所有测量的结果都与胎龄密切相关。然而，大多数极早产儿不需要特殊的教育支持，能够参加国家高中考试。
在公共资助的医疗体系中，大多数在可存活的胎龄出生的婴儿都可以实现高质量的存活。结果表明，胎龄与结局呈正相关。早期足月妊娠的结局比足月出生的儿童差。
