Infants born at the threshold of viability in relation to neonatal mortality: Colorado, 1991 to 2003.
Infants born at the threshold of viability in relation to neonatal mortality: Colorado, 1991 to 2003.
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出生于存活阈值的婴儿与新生儿死亡率的关系：科罗拉多州，1991 年至 2003 年。
DOI：
10.1038/sj.jp.7211918
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Hernández,JA
中科院分区：
文献类型：
--
作者：
Kamath,BD;Box,TL;Simpson,M;Hernández,JA
目的：为了确定的贡献，出生在阈值的婴儿的生存能力（定义为< 750克出生体重）和区域化的围产期护理的新生儿死亡率（NMR）在科罗拉多的作用研究设计：我们进行了一项回顾性队列研究，评价所有活产在科罗拉多从1991年至2003年，并比较期间1991年至1996年与1997年至2003.Result：整体未经调整的NMR的两个时间段分别为4.3和4.4每1000例活产，分别（P= 0.42）。出生体重< 750 g的婴儿占总NMR的比例从45.0%增加到54.5%（P< 0.01）。< 750 g婴儿的死亡几率在不同时间段之间增加（比值比1.3，95%置信区间1.11，1.61）。然而，对于所有出生体重类别，NMR在时间段之间降低，直到婴儿< 600 g。在区域化方面，在三级保健中心出生的体重< 750 g的婴儿数量在两个时间段之间略有增加（69.6%对73.3%; P= 0.04）;然而，调整后的分析显示，不同时间段之间的区域化实践没有差异。不考虑时间段，出生在III级中心的婴儿体重< 750 g的死亡率风险降低60%时，出生在非III级中心的< 750 g的婴儿相比（P< 0.01; 95%CI 0.30，0.52）。结论：尽管新生儿医学的进步，在1991年至1996年和1997年至2003年期间，在科罗拉多州的总体NMR保持不变。处于生存能力阈值的婴儿继续对科罗拉多的核磁共振产生很大影响，在新生儿死亡总数中占更大比例。虽然结果表明，在三级中心出生的< 750 g婴儿的死亡风险显著降低，但区域化的做法在两个时期之间没有改变。改进转诊做法的标准化工作，以确保在三级中心分娩< 750 g的婴儿，可能会减少这些婴儿对NMR的影响。虽然科罗拉多的总体NMR在两个时间段之间没有变化，但> 600 g的婴儿的NMR显著降低，这表明需要重新评估划定生存能力阈值的边界，因为它可能已被推到低于先前定义的水平。
Objective:To determine the contribution of infants born at the threshold of viability (defined as< 750 g birth weight) and the role of regionalization of perinatal care on the neonatal mortality rate (NMR) in Colorado.Study Design:We performed a retrospective cohort study, evaluating all live births in Colorado from 1991 to 2003, and comparing the periods 1991 to 1996 versus 1997 to 2003.Result:The overall unadjusted NMR of the two time periods was 4.3 and 4.4 per 1000 live births, respectively (P= 0.42). The contribution of infants with birth weights< 750 g to the overall NMR increased from 45.0 to 54.5%(P< 0.01). The odds of death for infants< 750 g increased between time periods (Odd ratio 1.3, 95% Confidence interval 1.11, 1.61). However, NMR decreased between time periods for all birth weight categories, until infants< 600 g. With respect to regionalization, the number of infants< 750 g born in a level III care center increased slightly between the two time periods (69.6 versus 73.3%; P= 0.04); however, adjusted analysis showed no difference in the practice of regionalization between time periods. Regardless of time period, infants who weighed< 750 g born in a level III center had 60% lower mortality risk when compared to< 750 g infants born in a non-level III center (P< 0.01; 95% CI 0.30, 0.52).Conclusion:Despite advances in neonatal medicine, the overall NMR in the state of Colorado remained unchanged between the time periods of 1991 to 1996 and 1997 to 2003. Infants at the threshold of viability continue to have a large impact on the Colorado NMR, making up a larger proportion of overall neonatal deaths. While the results demonstrate that the risk of mortality is significantly reduced for< 750 g infants born in a level III center, the practice of regionalization has not changed between the two time periods. Improved efforts to standardize the referral practices to ensure delivery of< 750 g infants in level III centers could potentially reduce the impact of these infants on the NMR. While the overall NMR in Colorado has not changed between the two time periods, the NMR for infants> 600 g has significantly decreased, suggesting that the boundary delineating the threshold of viability needs reevaluation, as it may have been pushed lower than previously defined.