Volume of Neonatal Care and Survival without Disability at 2 Years in Very Preterm Infants: Results of a French National Cohort Study
Volume of Neonatal Care and Survival without Disability at 2 Years in Very Preterm Infants: Results of a French National Cohort Study
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DOI：
10.1016/j.jpeds.2019.06.001
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发表时间：
2019-10-01
影响因子：
5.1
通讯作者：
Fresson, Jeanne
中科院分区：
文献类型：
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作者：
Desplanches, Thomas;Blonde, Beatrice;Fresson, Jeanne
目的探讨新生儿重症监护室（NICU）容量与存活率的关系，在极早产儿2岁时的神经运动和感觉障碍。研究设计（《怀孕小年龄流行病学研究》-2）国家预期人口-采用基于队列研究的方法，纳入了2011年在66家三级医院妊娠满24至30周的2 447名活产婴儿。结果是无残疾生存（脑瘫粗大运动功能分类系统2-5级，有或无单侧或双侧失明或耳聋）。单位根据数量分为四分位数，定义为极早产儿的年度入院。结果新生儿活动量低的医院出院时生存率较低（aOR 0.55，95%CI 0.33-0.91）。2年无神经运动和感觉障碍的生存率随着医院容量的增加而增加，最高容量单位从75%增加到80.7%。在校正了胎龄、小于胎龄、性别、母亲年龄、不孕治疗、多胎妊娠、早产的主要原因、父母的社会经济地位和母亲出生的国家后，新生儿活动量较低的医院中，无神经运动或感觉障碍的存活率显著较低（aOR 0.60，95%CI 0.38-0.95）比在最高的四分位数hospitals.Conclusions这些结果表明，较低的新生儿重症监护病房体积与较低的生存率没有增加残疾在2年。这些结果可能是有用的，以产生改进围产期区域化。
Objectives To investigate the relation between neonatal intensive care unit (NICU) volume and survival, and neuromotor and sensory disabilities at 2 years in very preterm infants.Study design The EPIPAGE-2 (Etude Epidemiologique sur les Petits Ages Gestationnels-2) national prospective population-based cohort study was used to include 2447 babies born alive in 66 level III hospitals between 24 and 30 completed weeks of gestation in 2011. The outcome was survival without disabilities (levels 2-5 of the Gross Motor Function Classification System for cerebral palsy with or without unilateral or bilateral blindness or deafness). Units were grouped in quartiles according to volume, defined as the annual admissions of very preterm babies. Multivariate logistic regression analyses with population average models were used.Results Survival at discharge was lower in hospitals with lower volumes of neonatal activity (aOR 0.55, 95% CI 0.33-0.91). Survival without neuromotor and sensory disabilities at 2 years increased with hospital volume, from 75% to 80.7% in the highest volume units. After adjustment for gestational age, small for gestational age, sex, maternal age, infertility treatment, multiple pregnancy, principal cause of prematurity, parental socioeconomic status, and mother's country of birth, survival without neuromotor or sensory disabilities was significantly lower in hospitals with a lower volume of neonatal activity (aOR 0.60, 95% CI 0.38-0.95) than in the highest quartile hospitals.Conclusions These results suggest that lower neonatal intensive care unit volume is associated with lower survival without an increase in disabilities at 2 years. These results could be useful to generate improvements of perinatal regionalization.