Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
Am J Perinatol. 2021 Jul;38(9):880-888. doi: 10.1055/s-0040-1722606. Epub 2021 Jan 6.
The aim of the study is to describe the rates of neonatal death and severe neonatal morbidity in a contemporary cohort, as well as to evaluate the predictive value of birth gestational age (GA) and birth weight, independently and combined, for neonatal mortality and morbidity in the same contemporary cohort.
We performed a secondary analysis of an international, multicenter randomized controlled trial of delayed umbilical cord clamping versus umbilical cord milking in preterm infants born at 23 to 31 weeks of gestation. The current analysis was restricted to infants delivered <28 weeks. The primary outcomes of this analysis were neonatal death and a composite of severe neonatal morbidity. Incidence of outcomes was compared by weeks of GA, with planned subanalysis comparing small for gestational age (SGA) versus non-SGA neonates. Multivariable logistic regression was then used to model these outcomes based on birth GA, birth weight, or a combination of both as primary independent predictors to determine which had superior ability to predict outcomes.
Of 474 neonates in the original trial, 180 (38%) were included in this analysis. Overall, death occurred in 27 (15%) and severe morbidity in 139 (77%) neonates. Rates of mortality and morbidity declined with increasing GA (mortality 54% at 23 vs. 9% at 27 weeks). SGA infants ( = 25) had significantly higher mortality compared with non-SGA infants across all GAs ( < 0.01). There was no difference in the predictive value for neonatal death or severe morbidity between the three prediction options (GA, birth weight, or GA and birth weight).
Death and severe neonatal morbidity declined with advancing GA, with higher rates of death in SGA infants. Birth GA and birth weight were both good predictors of outcomes; however, combining the two was not more predictive, even in SGA infants.
· We performed a secondary analysis of multicenter randomized clinical trials.. · The study included only extremely preterm neonates <28 weeks.. · We provide rates of neonatal morbidity in a contemporary cohort..
本研究旨在描述当代队列中新生儿死亡和严重新生儿发病率的比率，并评估出生胎龄（GA）和出生体重的预测价值，分别和联合用于同一当代队列中的新生儿死亡率和发病率。
我们对一项国际多中心随机对照试验进行了二次分析，该试验比较了 23 至 31 孕周早产儿延迟脐带夹闭与脐带挤奶的效果。本分析仅限于<28 周分娩的婴儿。本分析的主要结局为新生儿死亡和严重新生儿发病率的综合指标。通过 GA 周数比较结局的发生率，并计划进行亚分析比较小于胎龄儿（SGA）与非 SGA 新生儿。然后，使用多变量逻辑回归模型根据出生 GA、出生体重或两者的组合作为主要独立预测因素来预测这些结局，以确定哪种方法具有更好的预测结局的能力。
在原始试验的 474 名新生儿中，有 180 名（38%）纳入本分析。总体而言，27 名（15%）新生儿死亡，139 名（77%）新生儿发生严重并发症。死亡率和发病率随着 GA 的增加而降低（23 周时为 54%，27 周时为 9%）。在所有 GA 中，SGA 婴儿（n=25）的死亡率明显高于非 SGA 婴儿（<0.01）。三种预测方法（GA、出生体重或 GA 和出生体重）对新生儿死亡或严重发病率的预测价值均无差异。
随着 GA 的增加，死亡和严重新生儿发病率下降，SGA 婴儿的死亡率更高。出生 GA 和出生体重都是结局的良好预测因素；然而，即使在 SGA 婴儿中，两者结合也没有更具预测性。
·我们对多中心随机临床试验进行了二次分析。·本研究仅包括<28 周的极早产儿。·我们提供了当代队列中新生儿发病率的发生率。
