Expansion of community-based perinatal care in California.
Expansion of community-based perinatal care in California.
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DOI：
10.1038/sj.jp.7210824
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发表时间：
2002-12-01
期刊：
影响因子：
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通讯作者：
Chavez, Gilberto
中科院分区：
文献类型：
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作者：
Gould, Jeffrey B;Marks, Amy R;Chavez, Gilberto
目的：在加州，拥有社区新生儿重症监护室（NICU）的医院从1990年的17家增加到1997年的52家。本研究的目的是调查他们的生长对特定水平的出生分布、急症和新生儿死亡率的影响。研究设计：按护理水平分析了1990年至1997年出生的总共4，563，900名婴儿。我们检查了出生地点和视力的变化。无先天性异常的单胎极低出生体重儿（VLBW）的新生儿死亡率被用来评估特定水平survival.Results的差异：在医院与社区NICU的活产率从8.6%上升到28.6%，VLBW出生率从11.7%上升到37.4%。出生和VLBW出生在区域NICU下降，而敏锐度不变。在社区或地区NICU医院出生的VLBW婴儿的新生儿死亡率没有差异。极低出生体重儿出生在其他层次的护理死亡率显着higher.CONCLUSION：监测社区新生儿重症监护病房的快速增长，支持新生儿运输的区域化系统代表了不断发展的区域化。极低出生体重儿的存活率在社区和地区医院相似，高于其他分娩环境。减少在初级保健和中级新生儿重症监护医院的极低出生体重儿出生仍然是区域化的一个重要目标。电话：+86-10 - 8888888传真：+86-10 - 88888888
OBJECTIVE: In California, hospitals with Community Neonatal Intensive Care Units (NICUs) increased from 17 in 1990 to 52 in 1997. The purpose of this study was to investigate the effects of their growth on level-specific distribution of births, acuity, and neonatal mortality.STUDY DESIGN: A total of 4,563,900 infants born from 1990 to 1997 were analyzed by levels of care. We examined shifts in birth location and acuity. Neonatal mortality for singleton very-low-birth-weight (VLBW) infants without congenital abnormalities was used to assess differences in level-specific survival.RESULTS: Live births at hospitals with Community NICUs increased from 8.6% to 28.6%, and VLBW births increased from 11.7% to 37.4%. Births and VLBW births at Regional NICUs decreased, whereas acuity was unchanged. There were no differences in neonatal mortality of VLBW infants born at Community or Regional NICU hospitals. Mortality for VLBW births at other levels of care was significantly higher.CONCLUSION: The rapid growth of monitored Community NICUs supported by a regionalized system of neonatal transport represents an evolving face of regionalization. Survival of VLBW births was similar at Community and Regional hospitals and higher than in other birth settings. Reducing VLBW births at Primary Care and Intermediate NICU hospitals continues to be an important goal of regionalization. doi:10.1038/sj.jp.7210824