Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
Early Hum Dev. 2022 Aug;171:105618. doi: 10.1016/j.earlhumdev.2022.105618. Epub 2022 Jun 24.
A small group of extremely preterm infants survive to 36 weeks postmenstrual age (PMA), but die before discharge from neonatal care.
To investigate which epidemiological and clinical parameters were related to death after 36 weeks PMA in extremely preterm infants.
Retrospective whole-population study.
All infants born <28 weeks of gestation admitted to a neonatal unit in England between 2014 and 2018.
Mortality after 36 weeks PMA and before discharge from neonatal care. Bronchopulmonary dysplasia (BPD) defined as any respiratory support at 36 weeks PMA.
Death after 36 weeks PMA occurred in 156 of a total of 11.747 included infants (1.3 %) and at a median (IQR) age of 130 (93-164) days. A lower gestational age [Odds Ratio: 0.82, 95 % CI:0.72-0.94, adjusted p = 0.005], lower birth weight z-score [Odds Ratio: 0.45, 95 % CI:0.36-0.56, adjusted p < 0.001], greater absolute difference in weight z-score from birth to 36 weeks PMA [Odds Ratio: 0.46, 95 % CI:0.38-0.56, adjusted p < 0.001] were independently associated with death after 36 weeks PMA. A diagnosis of BPD [Odds Ratio: 4.57, 95 % CI:2.19-9.54, adjusted p < 0.001] and of necrotising enterocolitis requiring surgery [Odds Ratio: 2.81, 95 % CI:1.82-4.34, adjusted p < 0.001] were also independently associated with death after 36 weeks PMA.
Mortality of extremely preterm infants after 36 weeks postmenstrual age is associated with lower gestational age and more impaired growth. The diagnoses of bronchopulmonary dysplasia and necrotising enterocolitis were associated with a higher risk of death after 36 weeks postmenstrual age and before discharge from neonatal care.
一小部分极早产儿能存活至胎龄 36 周（PMA），但在新生儿护理出院前死亡。
研究哪些流行病学和临床参数与极早产儿胎龄 36 周后死亡相关。
回顾性全人群研究。
2014 年至 2018 年在英国一家新生儿病房收治的所有胎龄<28 周的婴儿。
胎龄 36 周 PMA 后至新生儿护理出院前的死亡率。胎龄 36 周 PMA 时存在任何呼吸支持的支气管肺发育不良（BPD）。
在总共纳入的 11747 名婴儿中，有 156 名（1.3%）在胎龄 36 周 PMA 后死亡，中位（IQR）年龄为 130（93-164）天。较低的胎龄[比值比：0.82，95%置信区间：0.72-0.94，调整后 p=0.005]、较低的出生体重 z 评分[比值比：0.45，95%置信区间：0.36-0.56，调整后 p<0.001]、胎龄 36 周 PMA 时体重 z 评分的绝对差值较大[比值比：0.46，95%置信区间：0.38-0.56，调整后 p<0.001]与胎龄 36 周 PMA 后死亡独立相关。BPD 诊断[比值比：4.57，95%置信区间：2.19-9.54，调整后 p<0.001]和需要手术治疗的坏死性小肠结肠炎[比值比：2.81，95%置信区间：1.82-4.34，调整后 p<0.001]也与胎龄 36 周 PMA 后死亡独立相关。
胎龄 36 周后极早产儿的死亡率与较低的胎龄和更严重的生长障碍有关。BPD 和坏死性小肠结肠炎的诊断与胎龄 36 周 PMA 后和新生儿护理出院前的死亡风险增加相关。
