The Differential Impact of Delivery Hospital on the Outcomes of Premature Infants
The Differential Impact of Delivery Hospital on the Outcomes of Premature Infants
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DOI：
10.1542/peds.2011-2820
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发表时间：
2012-08-01
期刊：
影响因子：
8
通讯作者：
Small, Dylan S.
中科院分区：
文献类型：
--
作者：
Lorch, Scott A.;Baiocchi, Michael;Small, Dylan S.
背景：由于在没有高级别NICU的医院分娩的妇女比例更高，因此关于过去20年来医院分娩对早产儿结局的影响，或者这些影响在不同围产期区划系统的州之间的差异的信息很少。方法：对1995年至2005年宾夕法尼亚州、加利福尼亚州和密苏里州1995年至2003年期间所有胎龄在23周至37周之间(N=1 328 132)的医院分娩进行了一项基于人群的回顾性队列研究。结果：在高级NICU分娩的婴儿在宾夕法尼亚州(每1000次分娩死亡人数减少7.8人，95%可信区间[CI]4.1-11.5)、加利福尼亚州(每1000次分娩死亡人数减少2.7人，95%可信区间为0.9-4.5)和密苏里州(死亡人数/1000人分娩减少12.6人，95%可信区间2.6-22.6)。在高级别NICU分娩的大多数并发症的发生率相似，除了密苏里州高级别NICU的较低的支气管肺发育不良发生率(9.5例/1000次分娩，95%CI 0.7-18.4)和宾夕法尼亚州和加利福尼亚州高级别NICU的较高感染率。住院分娩、住院死亡率和并发症之间的关系在3个州不同。结论：高危婴儿在高级别NICU分娩时，新生儿结局比以前报道的更大，尽管影响在不同的州有所不同，这可能是由于不同的区划方法所致。儿科2012；130：270-278
BACKGROUND: Because greater percentages of women deliver at hospitals without high-level NICUs, there is little information on the effect of delivery hospital on the outcomes of premature infants in the past 2 decades, or how these effects differ across states with different perinatal regionalization systems.METHODS: A retrospective population-based cohort study was constructed of all hospital-based deliveries in Pennsylvania and California between 1995 and 2005 and Missouri between 1995 and 2003 with a gestational age between 23 and 37 weeks (N = 1 328 132). The effect of delivery at a high-level NICU on in-hospital death and 5 complications of premature birth was calculated by using an instrumental variables approach to control for measured and unmeasured differences between hospitals.RESULTS: Infants who were delivered at a high-level NICU had significantly fewer in-hospital deaths in Pennsylvania (7.8 fewer deaths/1000 deliveries, 95% confidence interval [CI] 4.1-11.5), California (2.7 fewer deaths/1000 deliveries, 95% CI 0.9-4.5), and Missouri (12.6 fewer deaths/1000 deliveries, 95% CI 2.6-22.6). Deliveries at high-level NICUs had similar rates of most complications, with the exception of lower bronchopulmonary dysplasia rates at Missouri high-level NICUs (9.5 fewer cases/1000 deliveries, 95% CI 0.7-18.4) and higher infection rates at high-level NICUs in Pennsylvania and California. The association between delivery hospital, in-hospital mortality, and complications differed across the 3 states.CONCLUSIONS: There is benefit to neonatal outcomes when high-risk infants are delivered at high-level NICUs that is larger than previously reported, although the effects differ between states, which may be attributable to different methods of regionalization. Pediatrics 2012;130:270-278