SURVIVAL & HEALTH STATUS ANALYSIS OF PREMATURE, HIGH RISK DELIVERIES

这项全国性研究探讨了分娩医院的现有技术水平对三岁儿童早产、存活率和随后的健康状况的影响。这项全国性研究纳入了对极低出生体重儿以及胎儿和婴儿死亡的过度抽样。分娩的存活时间按婴儿死亡年龄或胎儿死亡胎龄、临产时的症状、干预措施的使用和分娩医院提供的技术支持水平进行分析，同时考虑胎龄和其他风险因素。三岁时的健康状况差异来自1991年国家卫生统计中心(NCHS)对1988年出生的所有儿童进行的具有全国代表性的调查的纵向跟踪调查中所包括的衡量标准。健康结果衡量标准包括发展情况、总体健康状况、慢性病、最近患病情况、呼吸暂停监测仪和耳管的使用情况、维生素/矿物质使用情况以及家庭治疗情况。围产期和儿科时期的医院和医生记录也包括在分析中。关于怀孕的研究得出的结论是，1988年，30%至45%的高危妇女在当时得到最高水平护理的医院外分娩。如果妇女生活在拥有高科技医院的县，在23-27周孕龄之间分娩的孕妇更有可能被归类为活产，而不是胎儿死亡。此外，与医院记录中的多种信息来源相比，在出生证明上报告23-27周孕周的情况下，约有10%的病例不准确。--高危妊娠、围产儿结局、孕龄

This national study addresses the effect of the available level of technology at the hospital of delivery on preterm deliveries, survival and subsequent health status of children at age three. The national study incorporates oversampling of very low birth weight infants as well as fetal and infant deaths. Survival time of deliveries are analyzed by age at death for infants or gestational age for a fetal death, symptoms at presentation, use of interventions, and level of technological support available at the delivery hospital while accounting for gestational age and other risk factors. Health status differences at age three are from measures included in a 1991 longitudinal follow-up of a nationally representative survey of all children born in 1988 performed by the National Center for Health Statistics (NCHS). The health outcome measures include development, overall health status, chronic conditions, recent illness, use of apnea monitors and ear tubes, vitamin/mineral use, and use of home treatments. Hospital and physician records from the perinatal and pediatric period are included in the analysis. Studies on pregnancies concluded that in 1988, between 30-45% of high risk women delivered outside of hospitals with the highest levels of care at the time. Classification as a live birth rather than a fetal death in pregnancies delivered between 23- 27 weeks gestational age was more likely if women lived in counties with high technology hospitals. Also, reporting of gestational age at 23-27 weeks is inaccurate on birth certificates in about ten percent of cases when compared to multiple information sources from hospital records. - high risk pregnancies, perinatal outcomes, gestational age