JAMA:大队列数据表明早产儿的长期健康损害风险
  • 纳入瑞典国家出生队列中256万新生儿数据,平均随访29.8年,记录AYAHOPE并发症指标和CCI并发症指标;
  • 随访期间,极早产(22-27周)、早早产(28-33周)、早产(34-36周)、轻早产(37-38周)以及足月产的儿童的无AYAHOPE并发症生存率分别为22.3%、48.5%、58.0%、61.2%、63.0%;
  • 无CCI并发症的生存率分别为32.5%、66.4%、77.1%、80.4%、81.8%;
  • 早产儿在未来的成长过程中,发生各种并发症的风险增高,且胎龄越小,风险越高。
主编推荐语
小笋干儿
本研究基于瑞典国家数据库,发现早产儿在未来30年内,发生各种并发症的风险是增高的。本研究采用AYAHOPE、CCI两个指标评估并发症的发生,在疾病负担研究中值得借鉴。同时,本研究结果也为早产儿的长期护理提供科学依据。
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JAMA [IF:51.273]

Prevalence of Survival Without Major Comorbidities Among Adults Born Prematurely

早产儿的无主要并发症生存率

10.1001/jama.2019.15040

2019-10-22, Article

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Importance : Preterm birth has been associated with cardiometabolic, respiratory, and neuropsychiatric disorders in adulthood. However, the prevalence of survival without any major comorbidities is unknown.
Objective : To determine the prevalence of survival without major comorbidities in adulthood among persons born preterm vs full-term.
Design, Setting, and Participants : National cohort study of all 2 566 699 persons born in Sweden from January 1, 1973, through December 31, 1997, who had gestational age data and who were followed up for survival and comorbidities through December 31, 2015 (ages 18-43 years).
Exposures : Gestational age at birth.
Main Outcomes and Measures : Survival without major comorbidities among persons born extremely preterm (22-27 weeks), very preterm (28-33 weeks), late preterm (34-36 weeks), or early term (37-38 weeks), compared with full-term (39-41 weeks). Comorbidities were defined using the Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) Comorbidity Index, which includes conditions that commonly manifest in adolescence or young adulthood, including neuropsychiatric disorders; and the Charlson Comorbidity Index (CCI), which includes major chronic disorders predictive of mortality in adulthood. Poisson regression was used to determine prevalence ratios and differences, adjusted for potential confounders.
Results : In this study population, 48.6% were female, 5.8% were born preterm, and the median age at end of follow-up was 29.8 years (interquartile range, 12.6 years). Of all persons born preterm, 54.6% were alive with no AYA HOPE comorbidities at the end of follow-up. Further stratified, this prevalence was 22.3% for those born extremely preterm, 48.5% for very preterm, 58.0% for late preterm, 61.2% for early term, and 63.0% for full-term. These prevalences were significantly lower for earlier gestational ages vs full-term (eg, adjusted prevalence ratios: extremely preterm, 0.35 [95% CI, 0.33 to 0.36; P < .001]; all preterm, 0.86 [95% CI, 0.85 to 0.86; P < .001]; adjusted prevalence differences: extremely preterm, −0.41 [95% CI, −0.42 to −0.40; P < .001]; all preterm, −0.09 [95% CI, −0.09 to −0.09; P < .001]). Using the CCI, the corresponding prevalences were 73.1% (all preterm), 32.5% (extremely preterm), 66.4% (very preterm), 77.1% (late preterm), 80.4% (early term), and 81.8% (full-term) (adjusted prevalence ratios: extremely preterm, 0.39 [95% CI, 0.38 to 0.41; P < .001]; all preterm, 0.89 [95% CI, 0.89 to 0.89; P < .001]; adjusted prevalence differences: extremely preterm, −0.50 [95% CI, −0.51 to −0.49; P < .001]; all preterm, −0.09 [95% CI, −0.09 to −0.09; P < .001]).
Conclusions and Relevance : Among persons born preterm in Sweden between 1973 and 1997, the majority survived to early to mid-adulthood without major comorbidities. However, outcomes were worse for those born extremely preterm.

First Authors:
Casey Crump

Correspondence Authors:
Casey Crump

All Authors:
Casey Crump,Marilyn A Winkleby,Jan Sundquist,Kristina Sundquist

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WebMD新闻网站

Majority of Premature Babies Grow Up Fine

2019-10-22

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