PDF(Pubmed)
Abstract：
BACKGROUND: Severe brain injury (SBI), including severe intraventricular haemorrhage (sIVH) and cystic periventricular leukomalacia, poses significant challenges for preterm infants, yet recent data and trends are limited.
METHODS: Analyses were conducted using the Australian and New Zealand Neonatal Network data on preterm infants born <32 weeks\' gestation admitted at Monash Children\'s Hospital, Australia, from January 2014 to April 2021. The occurrence and trends of SBI and sIVH among preterm infants, along with the rates and trends of death and neurodevelopmental impairment (NDI) in SBI infants were assessed.
RESULTS: Of 1,609 preterm infants, 6.7% had SBI, and 5.6% exhibited sIVH. A total of 37.6% of infants with SBI did not survive to discharge, with 92% of these deaths occurring following redirection of clinical care. Cerebral palsy was diagnosed in 65.2% of SBI survivors, while 86.4% of SBI survivors experienced NDI. No statistically significant differences were observed in the temporal trends of SBI (adjusted OR [95% CI] 1.08 [0.97-1.20]; p = 0.13) or sIVH (adjusted OR [95% CI] 1.09 [0.97-1.21]; p = 0.11). Similarly, there was no statistically significant difference noted in the temporal trend of the composite outcome, which included death or NDI among infants with SBI (adjusted OR [95% CI] 0.90 [0.53-1.53]; p = 0.71).
CONCLUSIONS: Neither the rates of SBI nor its associated composite outcome of death or NDI improved over time. A notable proportion of preterm infants with SBI faced redirection of care and subsequent mortality, while most survivors exhibited adverse neurodevelopmental challenges. The development of better therapeutic interventions is imperative to improve outcomes for these vulnerable infants.
METHODS: Analyses were conducted using the Australian and New Zealand Neonatal Network data on preterm infants born <32 weeks\' gestation admitted at Monash Children\'s Hospital, Australia, from January 2014 to April 2021. The occurrence and trends of SBI and sIVH among preterm infants, along with the rates and trends of death and neurodevelopmental impairment (NDI) in SBI infants were assessed.
RESULTS: Of 1,609 preterm infants, 6.7% had SBI, and 5.6% exhibited sIVH. A total of 37.6% of infants with SBI did not survive to discharge, with 92% of these deaths occurring following redirection of clinical care. Cerebral palsy was diagnosed in 65.2% of SBI survivors, while 86.4% of SBI survivors experienced NDI. No statistically significant differences were observed in the temporal trends of SBI (adjusted OR [95% CI] 1.08 [0.97-1.20]; p = 0.13) or sIVH (adjusted OR [95% CI] 1.09 [0.97-1.21]; p = 0.11). Similarly, there was no statistically significant difference noted in the temporal trend of the composite outcome, which included death or NDI among infants with SBI (adjusted OR [95% CI] 0.90 [0.53-1.53]; p = 0.71).
CONCLUSIONS: Neither the rates of SBI nor its associated composite outcome of death or NDI improved over time. A notable proportion of preterm infants with SBI faced redirection of care and subsequent mortality, while most survivors exhibited adverse neurodevelopmental challenges. The development of better therapeutic interventions is imperative to improve outcomes for these vulnerable infants.
摘要：
背景：重型脑损伤（SBI），包括严重的脑室内出血（sIVH）和囊性脑室周围白质软化，对早产儿构成重大挑战，然而，最近的数据和趋势是有限的。
方法：使用澳大利亚和新西兰新生儿网络数据对莫纳什儿童医院妊娠32周出生的早产儿进行了分析，澳大利亚,从2014年1月到2021年4月。早产儿SBI和sIVH的发生和趋势,评估了SBI婴儿的死亡率和神经发育障碍（NDI）的趋势。
结果：在1,609名早产儿中，6.7%有SBI，5.6%表现为sIVH。总共有37.6%的SBI婴儿没有存活出院，92%的死亡发生在临床护理重定向后。SBI幸存者中有65.2％被诊断为脑瘫，而86.4%的SBI幸存者经历了NDI。SBI（调整后OR[95%CI]1.08[0.97-1.20]；p=0.13）或sIVH（调整后OR[95%CI]1.09[0.97-1.21]；p=0.11）的时间趋势无统计学差异。同样，综合结局的时间趋势没有统计学上的显着差异，其中包括SBI婴儿的死亡或NDI(调整后OR[95%CI]0.90[0.53-1.53]；p=0.71)。
结论：SBI的发生率及其相关的死亡或NDI的复合结局均未随时间改善。患有SBI的早产儿中有相当比例面临护理重定向和随后的死亡率，而大多数幸存者表现出不利的神经发育挑战。开发更好的治疗干预措施对于改善这些脆弱婴儿的结局至关重要。
方法：使用澳大利亚和新西兰新生儿网络数据对莫纳什儿童医院妊娠32周出生的早产儿进行了分析，澳大利亚,从2014年1月到2021年4月。早产儿SBI和sIVH的发生和趋势,评估了SBI婴儿的死亡率和神经发育障碍（NDI）的趋势。
结果：在1,609名早产儿中，6.7%有SBI，5.6%表现为sIVH。总共有37.6%的SBI婴儿没有存活出院，92%的死亡发生在临床护理重定向后。SBI幸存者中有65.2％被诊断为脑瘫，而86.4%的SBI幸存者经历了NDI。SBI（调整后OR[95%CI]1.08[0.97-1.20]；p=0.13）或sIVH（调整后OR[95%CI]1.09[0.97-1.21]；p=0.11）的时间趋势无统计学差异。同样，综合结局的时间趋势没有统计学上的显着差异，其中包括SBI婴儿的死亡或NDI(调整后OR[95%CI]0.90[0.53-1.53]；p=0.71)。
结论：SBI的发生率及其相关的死亡或NDI的复合结局均未随时间改善。患有SBI的早产儿中有相当比例面临护理重定向和随后的死亡率，而大多数幸存者表现出不利的神经发育挑战。开发更好的治疗干预措施对于改善这些脆弱婴儿的结局至关重要。
