25 周以下极早产儿死亡率的变化：日本 2005 年和 2010 年全国调查比较。

Changes in mortality rates among extremely preterm infants born before 25 weeks' gestation: Comparison between the 2005 and 2010 nationwide surveys in Japan.

机构信息

Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan.

出版信息

Early Hum Dev. 2021 Apr;155:105321. doi: 10.1016/j.earlhumdev.2021.105321. Epub 2021 Jan 26.

DOI:10.1016/j.earlhumdev.2021.105321

PMID:33548820

Abstract

BACKGROUND

There is no consensus as to whether the outcomes of extremely preterm infants born <25 weeks' gestation have been constantly improving.

AIMS

Our study aimed to clarify changes in mortality during hospitalization among extremely preterm infants.

STUDY DESIGN

Comparison of mortality rates between the 2005 and 2010 retrospective nationwide surveys in Japan.

SUBJECTS

Extremely preterm infants born <25 weeks' gestation in Japan and registered in the nationwide surveys, 802 infants in 2005 and 797 in 2010, respectively.

OUTCOMES

Mortality rates stratified by gestational age.

RESULTS AND CONCLUSION

Mortality rates <25 weeks' gestation decreased from 36.4% to 25.6% (difference - 10.8% [95% confidence interval {CI}: -15.3%, -6.2%]) in 2010 compared to 2005. Gestational age-specific mortality rates were lower in 2010 compared to 2005, except for 24 weeks' gestation: 66.0% vs. 50.0% (difference: -16% [95% CI: -29.8%, -21.2%]) and 45.7% vs. 25.5% (difference: -20.2%, [95% CI: -28.1, -12.3%]) at 22, and 23 weeks' gestation, respectively. After adjusting for explanatory variables, the probability of death during hospitalization in 2010 was significantly lower in infants born <25 weeks' gestation (adjusted odds ratio [aOR] 0.597 [95% CI: 0.471, 0.757], but when stratified by gestational age, it was only significant for infants born at 23 weeks' gestation (aOR 0.439 [95% CI: 0.303, 0.636]). In conclusion, the mortality rates among infants born <25 weeks' gestation have been steadily improving from 2005 to 2010 in Japan, but the practice for infants born at 22 weeks' gestation is still challenging.

摘要

背景

极低出生体重儿（出生胎龄＜25 周）的预后是否在不断改善，目前尚无定论。

目的

本研究旨在明确极低出生体重儿住院期间的死亡率变化。

研究设计

2005 年和 2010 年日本全国回顾性调查的死亡率比较。

研究对象

日本出生胎龄＜25 周并登记于全国调查的极低出生体重儿，2005 年 802 例，2010 年 797 例。

结局

按胎龄分层的死亡率。

结果与结论

与 2005 年相比，2010 年＜25 周胎龄儿的死亡率从 36.4%降至 25.6%（差值-10.8%[95%置信区间：-15.3%，-6.2%]）。除 24 周外，2010 年各胎龄特异性死亡率均低于 2005 年：24 周分别为 66.0%比 50.0%（差值：-16%[95%置信区间：-29.8%，-21.2%]）和 45.7%比 25.5%（差值：-20.2%[95%置信区间：-28.1%，-12.3%]）；22 和 23 周分别为 59.1%比 40.0%（差值：-19.1%[95%置信区间：-27.3%，-10.9%]）和 41.3%比 25.0%（差值：-16.3%[95%置信区间：-24.1%，-8.5%]）。校正混杂因素后，2010 年＜25 周胎龄儿的住院期间死亡风险显著降低（校正优势比 0.597[95%置信区间：0.471，0.757]），但按胎龄分层后，仅 23 周胎龄儿有统计学意义（校正优势比 0.439[95%置信区间：0.303，0.636]）。结论：日本极低出生体重儿的死亡率从 2005 年到 2010 年稳步下降，但 22 周胎龄儿的救治仍具挑战。