The Distribution of Clinical Phenotypes of Preterm Birth Syndrome

作者：Fernando C. Barros, Aris T. Papageorghiou, César G. Victora, J. Alison Noble, Ruyan Pang, Jay D. Iams, Leila Cheikh Ismail, Robert L. Goldenberg, Ann Lambert, Michael S. Kramer, Maria Carvalho, Agustín Conde‐Agudelo, Yasmin A. Jaffer, Enrico Bertino, Michael G. Gravett, Doug Altman, Eric O. Ohuma, Manorama Purwar, Ihunnaya O. Frederick, Zulfiqar A Bhutta, Stephen Kennedy, José Villar · 发表于：Archives of Pediatrics and Adolescent Medicine · 年份：2015 · DOI：10.1001/jamapediatrics.2014.3040 · 被引用次数：172 · 研究领域：Preterm Birth and Chorioamnionitis、Infant Development and Preterm Care、Neonatal Respiratory Health Research

IMPORTANCE: Preterm birth has been difficult to study and prevent because of its complex syndromic nature. OBJECTIVE: To identify phenotypes of preterm delivery syndrome in the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. DESIGN, SETTING, AND PARTICIPANTS: A population-based, multiethnic, cross-sectional study conducted at 8 geographically demarcated sites in Brazil, China, India, Italy, Kenya, Oman, the United Kingdom, and the United States. A total of 60,058 births over a 12-month fixed period between April 27, 2009, and March 2, 2014. Of these, 53,871 had an ultrasonography estimate of gestational age, among which 5828 were preterm births (10.8%). Pregnancies were prospectively studied using a standardized data collection and online data management system. Newborns had anthropometric and clinical examinations using standardized methods and identical equipment and were followed up until hospital discharge. MAIN OUTCOMES AND MEASURES: The main study outcomes were clusters of preterm phenotypes and for each cluster, we analyzed signs of presentation at hospital admission, admission rates for neonatal intensive care for 7 days or more, and neonatal mortality rates. RESULTS: Twelve preterm birth clusters were identified using our conceptual framework. Eleven consisted of combinations of conditions known to be associated with preterm birth, 10 of which were dominated by a single condition. However, the most common single cluster (30.0% of the total preterm case...