Supplementary Material for: Temporal Trends in Severe Brain Injury and Associated Outcomes in Very Preterm Infants

Introduction: 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. We assessed 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.

Results: Of 1609 preterm infants, 6.7% had SBI, and 5.6% exhibited sIVH. 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).

Conclusion: 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. Development of better therapeutic interventions is imperative to improve outcomes for these vulnerable infants.

引言：严重脑损伤（severe brain injury, SBI）包括重症脑室内出血（severe intraventricular haemorrhage, sIVH）与囊性脑室周围白质软化症（cystic periventricular leukomalacia），对早产儿构成了严峻的诊疗挑战，但目前相关的最新数据与趋势研究仍较为匮乏。

研究方法：本研究采用澳大利亚新西兰新生儿网络（Australian and New Zealand Neonatal Network）的数据集，纳入2014年1月至2021年4月期间于澳大利亚莫纳什儿童医院收治的胎龄小于32周的早产儿。我们评估了早产儿中严重脑损伤与重症脑室内出血的发生情况及变化趋势，同时分析了严重脑损伤患儿的死亡率与神经发育障碍（neurodevelopmental impairment, NDI）发生率及其变化趋势。

研究结果：在1609名早产儿中，6.7%罹患严重脑损伤，5.6%出现重症脑室内出血。37.6%的严重脑损伤患儿未能存活至出院，其中92%的死亡事件发生于临床照护方案调整之后。65.2%的严重脑损伤存活患儿被诊断为脑性瘫痪，86.4%的存活患儿存在神经发育障碍（NDI）。严重脑损伤的时间趋势无统计学显著性差异（校正比值比[95%置信区间]：1.08，95%CI 0.97-1.20；P=0.13），重症脑室内出血的时间趋势亦无统计学显著性差异（校正比值比[95%置信区间]：1.09，95%CI 0.97-1.21；P=0.11）。同样，严重脑损伤患儿的复合结局（死亡或神经发育障碍）的时间趋势也未观察到统计学显著性差异（校正比值比[95%置信区间]：0.90，95%CI 0.53-1.53；P=0.71）。

研究结论：随时间推移，严重脑损伤的发生率及其相关的死亡或神经发育障碍复合结局均未得到改善。相当比例的严重脑损伤早产儿面临临床照护方案调整及后续死亡风险，而多数存活患儿存在不良神经发育预后。亟需开发更有效的治疗干预手段，以改善这类脆弱患儿的临床结局。