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首页> 外文期刊>Neonatology >Outborns or Inborns: Where Are the Differences? A Comparison Study of Very Preterm Neonatal Intensive Care Unit Infants Cared for in Australia and New Zealand and in Canada
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Outborns or Inborns: Where Are the Differences? A Comparison Study of Very Preterm Neonatal Intensive Care Unit Infants Cared for in Australia and New Zealand and in Canada

机译：外来的还是先天的：差异在哪里？澳大利亚，新西兰和加拿大照顾的极早新生儿重症监护室婴儿的比较研究

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Background: Very preterm infants born outside tertiary centers are at higher risks of adverse outcomes than inborn infants. Regionalization of perinatal care has been introduced worldwide to improve outcomes. Objective: To compare the risk-adjusted outcomes of both inborn and outborn infants cared for in tertiary neonatal intensive care units in Australia and New Zealand and in Canada. Methods: Deidentified data of infants <32 weeks' gestational age from the 29 Australian and New Zealand Neonatal Network units (ANZNN; n = 9,893) and 26 Canadian Neonatal Network units (CNN; n = 7,133) between 2005 and 2007 were analyzed for predischarge adverse outcomes. Results: ANZNN had lower rates of outborns compared to CNN (13 vs. 19%), particularly of late admissions (>2 days of age; 5.8 vs. 22.2% of outborns) who had high morbidity rates. After adjusting for confounding variables including gestation, ANZNN inborn infants had lower odds of chronic lung disease [CLD; 17.0 vs. 23.3%; adjusted odds ratio (AOR) = 0.70, 95% CI: 0.64-0.77], severe neurological injuries on ultrasound (SNI; 4.1 vs. 6.7%; AOR = 0.62, 95% CI: 0.53-0.73), severe retinopathy (5.6 vs. 7%; AOR = 0.71, 95% CI: 0.59-0.84) and necrotizing enterocolitis (3.5 vs. 5.4%; AOR = 0.67, 95% CI: 0.56-0.79), but no difference in mortality odds. After excluding the late outborn admissions, ANZNN outborns had lower odds of SNI (AOR = 0.43, 95% CI: 0.32-0.58) and CLD (AOR = 0.63, 95% CI: 0.490.81) than CNN. Conclusions: ANZNN inborn and early admitted outborn infants had lower odds of neonatal morbidities than their CNN counterparts. However, compared to ANZNN, the higher CNN rates of outborns and their late admissions are likely related to the differences in regionalization and referral practices, and may explain differences in outcomes. (C) 2015 S. Karger AG, Basel
机译：背景：三级中心以外出生的早产儿比出生后的婴儿发生不良后果的风险更高。围产期保健的区域化已在世界范围内引入，以改善结果。目的：比较在澳大利亚和新西兰以及加拿大的三级新生儿重症监护病房中接受照料的婴儿的风险调整后结局。方法：分析了2005年至2007年之间来自澳大利亚和新西兰的29个新生儿网络单位（ANZNN; n = 9,893）和26个加拿大的新生儿网络单元（CNN; n = 7,133）的小于32周胎龄的婴儿的鉴定数据。不良结果。结果：与CNN相比，ANZNN的新生儿出院率较低（13％比19％），尤其是高发病率的晚期入院（> 2天龄; 5.8 vs. 22.2％的新生儿）。在调整了包括妊娠在内的混淆变量后，ANZNN出生的婴儿患慢性肺病的几率较低[CLD; 17.0比23.3％;校正比值比（AOR）= 0.70，95％CI：0.64-0.77]，超声严重神经损伤（SNI; 4.1 vs. 6.7％; AOR = 0.62，95％CI：0.53-0.73），严重视网膜病变（5.6 vs 7％; AOR = 0.71，95％CI：0.59-0.84）和坏死性小肠结肠炎（3.5对5.4％; AOR = 0.67，95％CI：0.56-0.79），但死亡率差异无统计学意义。在排除晚期入院患者后，ANZNN新生儿的SNI（AOR = 0.43，95％CI：0.32-0.58）和CLD（AOR = 0.63，95％CI：0.490.81）的机率低于CNN。结论：ANZNN出生和早收的新生儿的新生儿发病几率低于CNN。但是，与ANZNN相比，较高的CNN新生儿出生率和延迟入院率可能与区域划分和转诊实践的差异有关，并且可以解释结果的差异。 （C）2015 S.Karger AG，巴塞尔

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