Trends in Resources for Neonatal Intensive Care at Delivery Hospitals for Infants Born Younger Than 30 Weeks' Gestation, 2009-2020.
Trends in Resources for Neonatal Intensive Care at Delivery Hospitals for Infants Born Younger Than 30 Weeks' Gestation, 2009-2020.
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2009-2020 年妊娠 30 周以下婴儿分娩医院新生儿重症监护资源趋势。
DOI：
10.1001/jamanetworkopen.2023.12107
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发表时间：
2023-05-01
影响因子：
13.8
通讯作者：
Horbar, Jeffrey D.
中科院分区：
文献类型：
--
作者：
Boghossian, Nansi S.;Geraci, Marco;Phibbs, Ciaran S.;Lorch, Scott A.;Edwards, Erika M.;Horbar, Jeffrey D.
在过去的十年里，医院的新生儿重症监护资源是否发生了变化？在这项队列研究中，包括2009年至2020年期间出生在22至29周的357 181名婴儿，在新生儿重症监护病房（NICUs）中，护理水平较低或出生量较低的新生儿出生率增加，而在新生儿重症监护病房（NICUs）中，护理水平较高或出生量较高的新生儿出生率下降。本研究的结果表明，极早产儿的去区域化程度越来越高。本队列研究调查了2009年至2020年间美国分娩医院新生儿重症监护资源分层的极早产儿分布。在一个理想的区域化系统中，所有早产婴儿都应在能够提供一切必要护理的大型三级医院分娩。基于分娩医院新生儿重症监护资源，探讨2009年至2020年间极度早产的分布是否发生了变化。这项回顾性队列研究于2009年至2020年在美国的822个佛蒙特牛津网络（VON）中心进行。参与者包括在妊娠22至29周出生的婴儿，在参与VON的中心分娩或转移。数据分析时间为2022年2月至12月。妊娠22至29周出生的医院。出生地新生儿重症监护病房（NICU）级别为A级，限制辅助通气或不手术；B、大手术；C，需要搭桥的心脏手术。B级中心进一步分为低容量（每年妊娠22至29周出生的婴儿<50例）和高容量（每年妊娠22至29周出生的婴儿≥50例）中心。高容量B级和C级中心合并，形成3种不同的NICU类别：A级，低容量B级，高容量B级和C级NICU。主要结果是总体和美国人口普查地区A级、低容量B级和高容量B级或C级新生儿重症监护病房医院出生百分比的变化。共纳入357 181例婴儿（平均胎龄26.4[2.1]周，男性188 761例（52.9%））。从各地区来看，太平洋地区（20239例[38.3%]）的新生儿出生比例最低，而南大西洋地区（48348例[62.7%]）在拥有大容量B级或c级新生儿重症监护病房的医院出生的比例最高。a级新生儿重症监护病房的出生人数增加了5.6% (95% CI， 4.3%至7.0%)，低容量B级新生儿重症监护病房的出生人数增加了3.6% (95% CI， 2.1%至5.0%)，而高容量B级或c级新生儿重症监护病房的出生人数减少了9.2% （95% CI, - 10.3%至- 8.1%）。到2020年，在拥有大容量B级或c级新生儿重症监护病房的医院中，不到一半的妊娠22至29周婴儿出生。美国大多数人口普查地区都遵循全国趋势；例如，在东北中部地区，在拥有高容量B级或c级新生儿重症监护病房的医院，出生率下降了10.9% [95% CI, - 14.0%至- 7.8%]，在西南中部地区，出生率下降了21.1% （95% CI, - 24.0%至- 18.2%）。本回顾性队列研究确定了出生在22至29周妊娠婴儿的出生地医院护理水平的去区域化趋势。这些发现应有助于鼓励决策者确定和执行战略，以确保不良后果风险最高的婴儿出生在有最佳机会获得最佳结果的医院。
Have neonatal intensive care resources at hospitals where infants born extremely preterm are delivered changed over the past decade? In this cohort study including 357 181 infants born at 22 to 29 weeks’ gestation between 2009 and 2020, births at neonatal intensive care units (NICUs) with lower levels of care or lower birth volumes increased, while births at NICUs with higher levels of care or higher birth volumes decreased. The findings of this study suggest increasing deregionalization of extremely preterm birth. This cohort study examines the distribution of extremely preterm births between 2009 and 2020 stratified by neonatal intensive care resources at the delivery hospital in the US. In an ideal regionalized system, all infants born very preterm would be delivered at a large tertiary hospital capable of providing all necessary care. To examine whether the distribution of extremely preterm births changed between 2009 and 2020 based on neonatal intensive care resources at the delivery hospital. This retrospective cohort study was conducted at 822 Vermont Oxford Network (VON) centers in the US between 2009 and 2020. Participants included infants born at 22 to 29 weeks’ gestation, delivered at or transferred to centers participating in the VON. Data were analyzed from February to December 2022. Hospital of birth at 22 to 29 weeks’ gestation. Birthplace neonatal intensive care unit (NICU) level was classified as A, restriction on assisted ventilation or no surgery; B, major surgery; or C, cardiac surgery requiring bypass. Level B centers were further divided into low-volume (<50 inborn infants at 22 to 29 weeks’ gestation per year) and high-volume (≥50 inborn infants at 22 to 29 weeks’ gestation per year) centers. High-volume level B and level C centers were combined, resulting in 3 distinct NICU categories: level A, low-volume B, and high-volume B and C NICUs. The main outcome was the change in the percentage of births at hospitals with level A, low-volume B, and high-volume B or C NICUs overall and by US Census region. A total of 357 181 infants (mean [SD] gestational age, 26.4 [2.1] weeks; 188 761 [52.9%] male) were included in the analysis. Across regions, the Pacific (20 239 births [38.3%]) had the lowest while the South Atlantic (48 348 births [62.7%]) had the highest percentage of births at a hospital with a high-volume B– or C-level NICU. Births at hospitals with A-level NICUs increased by 5.6% (95% CI, 4.3% to 7.0%), and births at low-volume B–level NICUs increased by 3.6% (95% CI, 2.1% to 5.0%), while births at hospitals with high-volume B– or C-level NICUs decreased by 9.2% (95% CI, −10.3% to −8.1%). By 2020, less than half of the births for infants at 22 to 29 weeks’ gestation occurred at hospitals with high-volume B– or C-level NICUs. Most US Census regions followed the nationwide trends; for example, births at hospitals with high-volume B– or C-level NICUs decreased by 10.9% [95% CI, −14.0% to −7.8%) in the East North Central region and by 21.1% (95% CI, −24.0% to −18.2%) in the West South Central region. This retrospective cohort study identified concerning deregionalization trends in birthplace hospital level of care for infants born at 22 to 29 weeks’ gestation. These findings should serve to encourage policy makers to identify and enforce strategies to ensure that infants at the highest risk of adverse outcomes are born at the hospitals where they have the best chances to attain optimal outcomes.
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DOI：
10.1016/0002-9378(95)90653-3
发表时间：
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影响因子：
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作者：
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通讯作者：
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