Palta M, Weinstein M R, McGuinness G, Gabbert D, Brady W, Peters M E
Department of Preventive Medicine, University of Wisconsin-Madison.
Arch Pediatr Adolesc Med. 1994 Dec;148(12):1295-301. doi: 10.1001/archpedi.1994.02170120057009.
To assess the impact of recent changes in neonatal intensive care on the mortality and morbidity of very-low-birth-weight neonates (< 1501 g).
Prospective cohort study.
Six neonatal intensive care units in Wisconsin and Iowa.
All very-low-birth-weight neonates who were admitted to the neonatal intensive care units the year before the availability of exogenous surfactant (n = 333), during the investigational new drug protocol for synthetic surfactant (Exosurf) (n = 347), and after the release of synthetic surfactant (n = 356) (designated as periods 1, 2, and 3, respectively).
None.
The percentage of neonates receiving exogenous surfactant in the three periods was 3%, 37%, and 56%, and the percentage receiving antenatal steroids was 12%, 17%, and 27% (P = .0001 for increase in both modalities). The percentage of neonates dying in the three periods was 23%, 14%, and 19% (P = .05 for downward trend). The percentage of neonates with intraventricular hemorrhage decreased in the subgroup weighing between 700 and 1350 g (35%, 28%, and 24%) (P = .04) and increased in the subgroup weighing below 700 g (8%, 41%, and 45%) (P = .03). The percentage of neonates with bronchopulmonary dysplasia increased from 21% to 36% between periods 1 and 2 (P = .003) and decreased to 27% (P = .04) in period 3. Antenatal steroid use was strongly associated with the decrease in intraventricular hemorrhage (odds ratio, 0.35) and mortality risk (odds ratio, 0.20).
Several developments in care have contributed to changes in mortality risk, incidence of intraventricular hemorrhage, and the severity of respiratory disease in very-low-birth-weight infants.
评估新生儿重症监护近期的变化对极低出生体重儿（<1501克）死亡率和发病率的影响。
前瞻性队列研究。
威斯康星州和爱荷华州的六个新生儿重症监护病房。
在可获得外源性表面活性剂前一年（n = 333）、合成表面活性剂（Exosurf）处于研究性新药方案期间（n = 347）以及合成表面活性剂发布后（n = 356）入住新生儿重症监护病房的所有极低出生体重儿（分别指定为第1、2和3期）。
无。
三个时期接受外源性表面活性剂的新生儿百分比分别为3%、37%和56%，接受产前类固醇的百分比分别为12%、17%和27%（两种方式均增加，P = 0.0001）。三个时期死亡的新生儿百分比分别为23%、14%和19%（呈下降趋势，P = 0.05）。体重在700至1350克之间的亚组中，脑室内出血的新生儿百分比下降（35%、28%和24%）（P = 0.04），而体重低于700克的亚组中则上升（8%、41%和45%）（P = 0.03）。支气管肺发育不良的新生儿百分比在第1期和第2期之间从21%增加到36%（P = 0.003），在第3期降至27%（P = 0.04）。产前使用类固醇与脑室内出血减少（比值比，0.35）和死亡风险降低（比值比，0.20）密切相关。
护理方面的多项进展促成了极低出生体重儿死亡风险、脑室内出血发生率和呼吸系统疾病严重程度的变化。
