Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia.
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
Am J Perinatol. 2021 Oct;38(12):1263-1270. doi: 10.1055/s-0040-1712165. Epub 2020 May 30.
The aim of this study is to examine factors associated with early neonatal (death within first 7 days of birth) and infant (death during the first year of life) mortality among infants born with myelomeningocele.
We examined linked data from the California Perinatal Quality Care Collaborative, vital records, and hospital discharge records for infants born with myelomeningocele from 2006 to 2011. Survival probability was calculated using Kaplan-Meier Product Limit method and 95% confidence intervals (CI) using Greenwood's method; Cox proportional hazard models were used to estimate unadjusted and adjusted hazard ratios (HR) and 95% CI.
Early neonatal and first-year survival probabilities among infants born with myelomeningocele were 96.0% (95% CI: 94.1-97.3%) and 94.5% (95% CI: 92.4-96.1%), respectively. Low birthweight and having multiple co-occurring birth defects were associated with increased HRs ranging between 5 and 20, while having congenital hydrocephalus and receiving hospital transfer from the birth hospital to another hospital for myelomeningocele surgery were associated with HRs indicating a protective association with early neonatal and infant mortality.
Maternal race/ethnicity and social disadvantage did not predict early neonatal and infant mortality among infants with myelomeningocele; presence of congenital hydrocephalus and the role of hospital transfer for myelomeningocele repair should be further examined.
· Mortality in myelomeningocele is a concern. · Social disadvantage was not associated with death. · Hospital-based factors should be further examined.
本研究旨在探讨与伴有脊髓脊膜膨出的新生儿（出生后 7 天内死亡）和婴儿（出生后第一年内死亡）死亡相关的因素。
我们分析了 2006 年至 2011 年期间加利福尼亚围产期质量协作组、生命记录和医院出院记录中与脊髓脊膜膨出相关的出生婴儿的相关数据。使用 Kaplan-Meier 乘积限法计算生存概率，并使用 Greenwood 法计算 95%置信区间（CI）；使用 Cox 比例风险模型估计未经调整和调整后的风险比（HR）和 95%CI。
伴有脊髓脊膜膨出的新生儿的早期新生儿和 1 年生存率分别为 96.0%（95%CI：94.1-97.3%）和 94.5%（95%CI：92.4-96.1%）。低出生体重和同时存在多种伴发出生缺陷与 HR 增加 5-20 倍相关，而先天性脑积水和因脊髓脊膜膨出手术从出生医院转院至其他医院与早期新生儿和婴儿死亡率呈 HR 表明保护相关。
母体种族/民族和社会劣势并不能预测伴有脊髓脊膜膨出的新生儿的早期新生儿和婴儿死亡率；先天性脑积水的存在和医院对脊髓脊膜膨出修复的作用应进一步研究。
·脊髓脊膜膨出的死亡率令人担忧。·社会劣势与死亡无关。·应进一步研究医院相关因素。
