Lorenz J M, Wooliever D E, Jetton J R, Paneth N
Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, USA.
Arch Pediatr Adolesc Med. 1998 May;152(5):425-35. doi: 10.1001/archpedi.152.5.425.
To summarize the literature on mortality rates and prevalences of major neurodevelopmental disabilities and to examine trends of these outcomes over time in extremely premature neonates.
MEDLINE was used to search the English literature for studies published since 1970 reporting on both mortality and disability in infants born at or before 26 weeks' gestation (extremely immature [EI] cohort), with a birth weight of 800 g or less (extremely small [ES] cohort), or subgroups of these.
Studies were included in the analysis if all of the following were reported: mortality; direct examination of 75% or more of the survivors; and the proportion of patients with at least 1 of the following disabilities: cerebral palsy, mental retardation, blindness, and deafness. Studies reporting cohorts included as a subset of cohorts in another study were excluded. Forty-two studies providing mortality and disability data for 20 cohorts of 4116 EI infants and 38 cohorts of 4345 ES infants born after 1972 met the inclusion criteria.
Data were abstracted from all studies that met these criteria by two of us (J.M.L. and D.E.W.), independently; the data were then cross-checked to ensure accuracy.
Survival averaged 41% for EI infants and 30% for ES infants, and it increased significantly with time. In contrast to mortality, the prevalences of major neurodevelopmental disabilities among survivors have not changed over time. The most common major disability was mental retardation, found in 14% of EI and ES survivors. Cerebral palsy was found in 12% of EI survivors and 8% of ES survivors, blindness was found in 8% of EI and ES survivors, and deafness was found in 3% of EI and ES survivors. Overall, 22% of EI survivors and 24% of ES survivors were classified as having at least 1 major disability. Each 100 EI or ES livebirths yielded 7 children with major disabilities; this prevalence was correlated with survival across cohorts.
The prevalence of disabilities had not changed among EI or ES survivors with increasing survival. However, increasing survival of these infants has resulted in a steadily increasing prevalence of children with disabilities.
总结关于主要神经发育障碍的死亡率和患病率的文献，并研究极早产儿中这些结果随时间的变化趋势。
使用MEDLINE检索自1970年以来发表的英文文献，这些研究报告了妊娠26周及以前出生的婴儿（极不成熟[EI]队列）、出生体重800克及以下的婴儿（极小[ES]队列）或这些亚组的死亡率和残疾情况。
如果报告了以下所有内容，则将研究纳入分析：死亡率；对75%或更多幸存者进行直接检查；以及患有以下至少一种残疾的患者比例：脑瘫、智力迟钝、失明和失聪。排除将所报告队列作为另一项研究中队列子集的研究。42项研究提供了1972年后出生的20个EI队列的4116名婴儿和38个ES队列的4345名婴儿的死亡率和残疾数据，符合纳入标准。
由我们两人（J.M.L.和D.E.W.）独立从所有符合这些标准的研究中提取数据；然后对数据进行交叉核对以确保准确性。
EI婴儿的平均存活率为41%，ES婴儿为30%，且随时间显著增加。与死亡率相反，幸存者中主要神经发育障碍的患病率并未随时间变化。最常见的主要残疾是智力迟钝，在EI和ES幸存者中占14%。EI幸存者中12%患有脑瘫，ES幸存者中8%患有脑瘫；EI和ES幸存者中8%失明；EI和ES幸存者中3%失聪。总体而言，22%的EI幸存者和24%的ES幸存者被归类为患有至少一种主要残疾。每100例EI或ES活产中有7名儿童患有主要残疾；这种患病率与各队列的存活率相关。
随着存活率的提高，EI或ES幸存者中的残疾患病率并未改变。然而，这些婴儿存活率的提高导致残疾儿童的患病率稳步上升。
