Does place of birth influence a healthy start to life?

澳大利亚每年有超过255,000名新生儿，在规划和提供方面的一个重大挑战是确保这些婴儿在拥有适当护理设施的医院出生。国际研究表明，出生前转移母亲比出生后转移婴儿会产生更好的婴儿结局。在澳大利亚，分娩发生在一系列医院，从小型乡村医院到三级产科和新生儿中心。然而，澳大利亚很少有研究关注基于出生地的婴儿结局。这项研究将使用现有的人口健康数据集来评估在出生前和出生时提供的护理及其对一岁以下婴儿结局的影响。它还将首次描述与出生和婴儿健康相关的医院护理利用情况。信息将从例行收集的出生、死亡和出生缺陷登记以及医院、助产士和围产期死亡审查数据中获得。婴儿健康结果的差异可能是由于怀孕前或怀孕期间发生的因素，也可能是由于出生时提供的护理不同所致。我们需要考虑产妇因素，以全面评估出生时护理水平的作用。我们将使用统计技术来“预测”婴儿的健康状况，看看出生地之间的差异是否真实存在。如果用不同的护理水平来解释差异，那么在提供怀孕和新生儿服务方面就有巨大的改进潜力。我们还将比较母体和新生儿转运的益处和后果，并评估医院成本。这项研究的结果可以应用于指导卫生服务政策和组织变革，以改善怀孕护理并优化婴儿结局，以健康地开始生命。

There are over 255,000 births in Australia each year and a major challenge in terms of planning and provision is to ensure that these babies are born in hospitals with the appropriate facilities to care for them. International studies suggest that transferring the mother before birth results in better infant outcomes than transferring the baby after birth. In Australia births occur in a range of hospitals, from small rural hospitals to tertiary obstetric and neonatal centres. However, few Australian studies have looked at infant outcomes based on place of birth. This study will use existing population health data sets to evaluate the provision of care prior to and at birth and the impact it has on infant outcomes up to one year of age. It will also describe for the first time the hospital care utilisation associated with birth and infant health. Information will be obtained from routinely-collected birth, death and birth defect registers, and hospital, midwives and perinatal death review data. Variations in health outcomes for babies may be due to factors that occur before or during pregnancy, or may be due to differences in the care provided at birth. We need to take account of maternal factors to comprehensively assess the role of level of care at birth. We will use statistical techniques to 'predict' infant health outcomes and see if differences between places of birth are real or not. If variations are explained by different levels of care then there is enormous potential for improvement in the provision of pregnancy and newborn services. We will also compare the benefits and consequences of maternal versus neonatal transfer, and assess hospital costs. The results of this study could be applied to direct health services policy and organisational changes to improve pregnancy care and optimise infant outcomes for a healthy start to life.