台南地区 1995-2016 年极早产儿的生存趋势、新生儿发病率和神经发育结局。

Trends in survival, neonatal morbidity and neurodevelopmental outcome of very preterm infants in Tainan, Southern Taiwan, 1995-2016.

机构信息

Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan; Department of Biotechnology and Food Technology, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan.

Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

出版信息

J Formos Med Assoc. 2021 Jun;120(6):1314-1323. doi: 10.1016/j.jfma.2020.12.025. Epub 2021 Jan 18.

DOI:10.1016/j.jfma.2020.12.025

PMID:33478783

Abstract

BACKGROUND

Using regression modeling analysis to investigate the breakpoints of the trends in survival-without-major-neonatal-morbidities (MNM) or -without-neurodevelopmental- impairment (NDI) by year and gestational age (GA) in preterm infants.

METHODS

We enrolled 2237 preterm infants (GA < 32 weeks) in Tainan, Taiwan. The trends in survival-without-MNM or -without-NDI by year (1995-2016) and GA (23-31 weeks), and the epochs and GA ranges with distinct changes were examined. Adjusted rate ratios (aRR) (95% confidence interval [CI]) were calculated using the rates in infants born at 23 weeks in 1995 as the reference.

RESULTS

For yearly trend, there were three epochs (1995-2000, 2001-2006, 2007-2016) with distinct changes in the rates of survival-without-MNM (aRR [95% CI] 1.07 [1.02-1.12], 1.04 [1.02-1.07], 1.02 [1.01-1.04]) and -without-NDI (1.03 [1.02-1.07], 1.02 [1.01-1.04], 1.01 [0.98-1.04]). For GA trend, the three GA ranges with different increases in the rates of survival-without-MNM were 23-26 (1.60 [1.31-1.94]), 27-28 (1.24 [1.14-1.34]) and 29-31 weeks (1.17 [1.02-1.34]), while those in the rates of survival-without-NDI were 23-25 (1.14 [1.03-1.25]), 26-28 (1.06 [1.02-1.12]) and 29-31 weeks (1.04 [1.02-1.07]). The trends in survival-without-MNM and -without-NDI increased over years in infants with GA 25-31 but not < 25 weeks.

CONCLUSION

The yearly trends in survival-without-MNM and -without-NDI had steady increases from 1995 to 2016 with distinct changes in three epochs, and the GA trends also increased with different rates per week in three GA ranges. Infants with GA < 25 weeks did not improve on the rates of survival-without-MNM or -without-NDI per year from 1995 to 2016.

摘要

背景

利用回归建模分析探讨早产儿无主要新生儿并发症（MNM）或无神经发育障碍（NDI）生存率随年份和胎龄（GA）的变化趋势的转折点。

方法

我们纳入了台湾台南的 2237 名早产儿（GA<32 周）。检查了生存率随年份（1995-2016 年）和 GA（23-31 周）的变化趋势，以及具有明显变化的时段和 GA 范围。使用在 1995 年出生于 23 周的婴儿的比率作为参考，计算调整后的比率比（aRR）（95%置信区间[CI]）。

结果

就年度趋势而言，在无 MNM 生存率（aRR [95%CI] 1.07 [1.02-1.12]、1.04 [1.02-1.07]、1.02 [1.01-1.04]）和无 NDI 生存率（aRR [95%CI] 1.03 [1.02-1.07]、1.02 [1.01-1.04]、1.01 [0.98-1.04]）方面存在三个明显变化的时期（1995-2000 年、2001-2006 年、2007-2016 年）。GA 趋势方面，无 MNM 生存率增加的三个 GA 范围分别为 23-26 周（1.60 [1.31-1.94]）、27-28 周（1.24 [1.14-1.34]）和 29-31 周（1.17 [1.02-1.34]），而无 NDI 生存率增加的三个 GA 范围分别为 23-25 周（1.14 [1.03-1.25]）、26-28 周（1.06 [1.02-1.12]）和 29-31 周（1.04 [1.02-1.07]）。GA 为 25-31 周但<25 周的婴儿，生存率无 MNM 和无 NDI 的年度趋势随时间呈稳定上升趋势。