J Paediatr Child Health. 1997 Apr;33(2):161-5.
To determine the survival and sensorineural disability rates in very preterm infants born in 1991-92, and to compare the results with contemporaneous normal birthweight controls and with preterm infants born in 1985-87.
This was a geographically determined cohort study in the state of Victoria, Australia of consecutive livebirths 23-27 weeks' gestational age born during 1991-92, and randomly selected contemporaneous normal birthweight (NBW) controls born during 1991-92 in the three level-III perinatal centres in the State. Consecutive livebirths 24-26 weeks gestational age born in the State during 1985-87 comprised another comparison group. The main outcome measures were survival and sensorineural disability rates at 2 years of age.
Of the 401 livebirths 23-27 weeks in 1991-92, 225 (56.1%) survived to 2 years of age. The survival rate for those 24-26 weeks was 57.4% (143/249), a statistically significant increase on the regional survival rate of 30.1% (95/316) in 1985-87. In 1991-92 births, the survival rate rose significantly with increasing gestational age, and was significantly higher than in 1985-87 at each of 24, 25, and 26 weeks. Of sensorineural impairments in preterm survivors at 2 years of age, the rate of blindness was significantly lower in 1991-92 (2.3%) compared with 1985-87 (8.4%), and the overall rates of sensorineural disability were not statistically different in 1991-92 compared with 1985-87. In 1991-92 preterm survivors, the survival rate free of disability rose significantly with increasing gestational age, and as a percentage of survivors the rate of disability overall fell with increasing gestational age. However, the rate of disability overall was much higher in preterm infants than NBW controls.
Survival rates of very preterm infants in this regional cohort have improved in the 1990s after the introduction of exogenous surfactant. Blindness at 2 years of age was significantly lower than in an earlier preterm cohort, but the rates of sensorineural disability still remain higher in very preterm survivors than for NBW controls. Although survival rates are lower and disability rates are higher with diminishing maturity, there is no obvious gestational age below which adverse neurological outcome in survivors would preclude active management on the basis of gestational age alone.
确定1991 - 1992年出生的极早产儿的存活率和感音神经性残疾率，并将结果与同期正常出生体重的对照组以及1985 - 1987年出生的早产儿进行比较。
这是一项在澳大利亚维多利亚州进行的基于地理位置的队列研究，研究对象为1991 - 1992年连续出生的孕23 - 27周的活产婴儿，以及在该州三个三级围产期中心随机选取的同期正常出生体重（NBW）的对照组。1985 - 1987年在该州出生的孕24 - 26周的连续活产婴儿构成另一个比较组。主要观察指标为2岁时的存活率和感音神经性残疾率。
在1991 - 1992年的401例孕23 - 27周的活产婴儿中，225例（56.1%）存活至2岁。孕24 - 26周婴儿的存活率为57.4%（143/249），与1985 - 1987年该地区30.1%（95/316）的存活率相比有统计学显著提高。在1991 - 1992年出生的婴儿中，存活率随孕周增加而显著上升，且在孕24、25和26周时均显著高于1985 - 1987年。在2岁的早产存活者中，1991 - 1992年失明率（2.3%）显著低于1985 - 1987年（8.4%），1991 - 1992年与1985 - 1987年感音神经性残疾的总体发生率无统计学差异。在1991 - 1992年的早产存活者中，无残疾的存活率随孕周增加而显著上升，且作为存活者的百分比，总体残疾率随孕周增加而下降。然而，早产儿的总体残疾率远高于NBW对照组。
在引入外源性表面活性剂后，该地区队列中极早产儿的存活率在20世纪90年代有所提高。2岁时的失明率显著低于早期的早产队列，但极早产存活者的感音神经性残疾率仍高于NBW对照组。尽管随着成熟度降低存活率降低且残疾率升高，但没有明显的孕周界限，低于该界限存活者的不良神经学结局会排除仅基于孕周进行积极管理的可能性。
