INCREASED MORTALITY OF PRETERM INFANTS TRANSFERRED BETWEEN TERTIARY PERINATAL CENTERS
INCREASED MORTALITY OF PRETERM INFANTS TRANSFERRED BETWEEN TERTIARY PERINATAL CENTERS
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DOI：
10.1136/bmj.297.6656.1098
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发表时间：
1988-10-29
影响因子：
105.7
通讯作者：
KITCHEN, WH
中科院分区：
文献类型：
--
作者：
BOWMAN, E;DOYLE, LW;KITCHEN, WH
在超过18个月的时间里，在三级围产期中心出生的需要重症监护的婴儿中，几乎四分之一在怀孕30周前出生，因为重症监护设施已全部被占用。如果剔除患有致命先天畸形的婴儿，34名被转移的婴儿中有一半死亡；这是剩余111名婴儿死亡率(24%)的两倍。两组之间的差异是显著的(相对优势=3.1)，并在调整了任何胎龄差异后仍然如此(相对优势=4.0)。经Logistic函数回归调整潜在混杂变量后，转移者的死亡风险仍显著高于留置者(相对优势比=4.6，95%可信区间1.8~12.1)。由于对新生儿重症监护的需求是间歇性的和不可预测的，因此必须在围产期保健系统中建立更大的灵活性，以使在三级围产期中心分娩的早产儿能够在他们出生的地方得到护理。
Over 18 months almost one quarter of infants born before 30 weeks'' gestation in a tertiary perinatal centre who required intensive care had to be transferred to other tertiary centres because intensive care facilities were fully occupied. When infants with lethal congenital malformations were excluded half of the 34 infants who were transferred died; this was twice the mortality (24%) in the 111 infants remaining. The difference between the groups was significant (relative odds = 3.1) and remained so after adjustment for any discrepancies in gestational age (relative odds = 4.0). After adjustment for potential confounding variables by logistic function regression the risk of dying for those transferred remained significantly higher than that for infants who remained (relative odds = 4.6, 95% confidence interval 1.8 to 12.1). As the requirement for neonatal intensive care is episodic and unpredictable more flexibility has to be built into the perinatal health care system to enable preterm infants delivered in tertiary perinatal centres to be cared for where they are born.