Gestational Age and Risk of Mortality in Term-Born Critically Ill Neonates Admitted to PICUs in Australia and New Zealand.

Australia / epidemiology Critical Illness / mortality Female Gestational Age Humans Infant, Newborn Infant, Newborn, Diseases / mortality Intensive Care Units, Neonatal / statistics & numerical data Male New Zealand / epidemiology Risk Factors

Journal

Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501

Informations de publication

Date de publication:
08 2020
Historique:
entrez: 23 7 2020
pubmed: 23 7 2020
medline: 20 5 2021
Statut: ppublish

Résumé

Gestational age at birth is declining, probably because more deliveries are being induced. Gestational age is an important modifiable risk factor for neonatal mortality and morbidity. We aimed to investigate the association between gestational age and mortality in hospital for term-born neonates (≥ 37 wk') admitted to PICUs in Australia and New Zealand. Observational multicenter cohort study. PICUs in Australia and New Zealand. Term-born neonates (≥ 37 wk) admitted to PICUs. None MEASUREMENTS AND MAIN RESULTS:: We studied 5,073 infants born with a gestational age greater than or equal to 37 weeks and were less than 28 days old when admitted to a PICU in Australia or New Zealand between 2007 and 2016. The association between gestational age and mortality was estimated using a multivariable logistic regression model, adjusting for age, sex, indigenous status, Pediatric Index of Mortality version 2, and site. The median gestational age was 39.1 weeks (interquartile range, 38.2-40 wk) and mortality in hospital was 6.6%. Risk of mortality declined log-linearly with gestational age. The adjusted analysis showed a 20% (95% CI, 11-28%) relative reduction in mortality for each extra week of gestation beyond 37 weeks. The effect of gestation was stronger among those who received extracorporeal life support: each extra week of gestation was associated with a 44% (95% CI, 25-57%) relative reduction in mortality. Longer gestation was also associated with reduced length of stay in hospital: each week increase in gestation, the average length of stay decreased by 4% (95% CI, 2-6%). Among neonates born at "term" who are admitted to a PICU, increasing gestational age at birth is associated with a substantial reduction in the risk of dying in hospital. The maturational influence on outcome was more strongly noted in the sickest neonates, such as those requiring extracorporeal life support. This information is important in view of the increasing proportion of planned births in both high- and low-/middle-income countries.

Identifiants

DOI: 10.1097/CCM.0000000000004409 PMID: 32697505
pubmed: 32697505
doi: 10.1097/CCM.0000000000004409
pii: 00003246-202008000-00028
doi:

Types de publication

Journal Article Multicenter Study Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

e648-e656

Commentaires et corrections

Type : CommentIn

Références

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Auteurs

Siva P Namachivayam (SP)

Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia.
Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia.
Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia.
Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand.
Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia.
Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia.
Pediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia.
Pediatric Intensive Care Unit and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia.
Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia.
Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Pediatric Intensive Care Unit, The Sydney Children's Hospital, Sydney, NSW, Australia.

John B Carlin (JB)

Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia.
Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia.

Johnny Millar (J)

Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia.

Janet Alexander (J)

Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia.

Sarah Edmunds (S)

Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand.

Anusha Ganeshalingham (A)

Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand.

Jamie Lew (J)

Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia.

Simon Erickson (S)

Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia.

Warwick Butt (W)

Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia.
Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia.
Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia.
Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand.
Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia.
Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia.
Pediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia.
Pediatric Intensive Care Unit and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia.
Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia.
Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Pediatric Intensive Care Unit, The Sydney Children's Hospital, Sydney, NSW, Australia.

Luregn J Schlapbach (LJ)

Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia.
Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia.
Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia.
Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand.
Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia.
Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia.
Pediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia.
Pediatric Intensive Care Unit and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia.
Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia.
Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Pediatric Intensive Care Unit, The Sydney Children's Hospital, Sydney, NSW, Australia.

Subodh Ganu (S)

Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia.
Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia.

Marino Festa (M)

Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia.

Jonathan R Egan (JR)

Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia.

Gary Williams (G)

Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia.

Janelle Young (J)

Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia.

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Classifications MeSH

questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › Gestational Age and Risk of Mortality in...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie grave › Gestational Age and Risk of Mortality in...
questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Âge gestationnel › Gestational Age and Risk of Mortality in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Gestational Age and Risk of Mortality in...
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questionsmedicales.fr › Malformations et maladies congénitales, héréditaires et néonatales › Maladies néonatales › Gestational Age and Risk of Mortality in...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › Unités de soins intensifs pédiatriques › Unités de soins intensifs néonatals › Gestational Age and Risk of Mortality in...
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questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Gestational Age and Risk of Mortality in...