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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Mortality in low birth weight infants according to level of neonatal care at hospital of birth.
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Mortality in low birth weight infants according to level of neonatal care at hospital of birth.

机译：根据出生医院的新生儿保健水平，低体重儿的死亡率。

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OBJECTIVE: In 1976, the Committee on Perinatal Health recommended that hospitals with no neonatal intensive care unit (NICU) or intermediate NICUs transfer high-risk mothers and infants that weigh <2000 g to a regional NICU. This standard was based on expert opinion and has not been validated carefully. This study evaluated the effect of NICU level and patient volume at the hospital of birth on neonatal mortality of infants with a birth weight (BW) of <2000 g. METHODS: Birth certificates of 16 732 singleton infants who had a BW of <2000 g and were born in nonfederal hospitals in California in 1992 and 1993 were linked to death certificates and to discharge abstracts. The hospitals were classified by the level of NICU: no NICU, no intensive care; intermediate NICU, intermediate intensive care; community NICU, expanded intermediate intensive care; and regional NICU, tertiary intensive care. A logistic regression model that controlled for demographic risks, diagnoses, transfer, average NICU census, and NICU level was estimated using death within the first 28 days or first year of life if continuously hospitalized as the main outcome measure. RESULTS: Compared with birth in a hospital with a regional NICU, risk-adjusted mortality of infants with BW of <2000 g was higher when birth occurred in hospitals with no NICU (odds ratio [OR]: 2.38; 95% confidence interval [CI]: 1.81-3.13), an intermediate NICU (OR: 1.92; 95% CI: 1.44-2.54), or a small (average census <15) community NICU (OR: 1.42; 95% CI: 1.14-1.76). Risk-adjusted mortality for infants who were born in hospitals with a large (average census > or =15) community NICU was not statistically different compared with those with a regional NICU (OR: 1.11; 95% CI: 0.87-1.43). Except for large community NICUs, all of these ORs are larger when the data are restricted to infants with BW of <1500 g or BW of <1250 g and smaller for BW between 1250 g and 1999 g and 1500 g and 1999 g. For large community NICUs, the results are similar for the smaller BW intervals and significant only for the larger BW interval. CONCLUSIONS: These results support the recommendation that hospitals with no NICU or intermediate NICUs transfer high-risk mothers with estimated fetal weight of <2000 g to a regional NICU. For infants with BW of <2000 g, birth at a hospital with a regional NICU is associated with a lower risk-adjusted mortality than birth at a hospital with no NICU, intermediate NICU of any size, or small community NICU. Subsequent neonatal transfer to a regional NICU only marginally decreases the disadvantage of birth at these hospitals. The evidence for the few hospitals with large community NICUs is mixed. Although the data point to higher mortality in large community NICUs, they are not conclusive and additional study is needed on the mortality effects of large community NICUs. Greater efforts should be made to deliver infants with expected BW of <2000 g at hospitals with regional NICUs.
机译：目的：1976年，围产期健康委员会建议没有新生儿重症监护病房（NICU）或中级重症监护病房的医院将体重<2000 g的高危母亲和婴儿转移到区域重症监护病房。该标准基于专家意见，未经仔细验证。这项研究评估了新生儿重症监护病房（NICU）水平和患者住院量对出生体重（BW）<2000 g的婴儿的新生儿死亡率的影响。方法：将1992年和1993年在加利福尼亚州的非联邦医院出生的16732例BW <2000 g的单身婴儿的出生证明与死亡证明联系起来，并分发摘要。医院按重症监护病房的等级进行分类：无重症监护病房，无重症监护室;无重症监护病房。中级重症监护病房，中级重症监护;社区重症监护病房，扩大了中级重症监护;以及重症监护病房，三级重症监护室。如果持续住院作为主要结局指标，则使用生命的头28天或第一年内的死亡来估算可控制人口统计学风险，诊断，转移，平均重症监护病房普查和重症监护病房水平的逻辑回归模型。结果：与没有重症监护病房的医院的出生相比，无重症监护病房的医院中出生体重＜2000 g的婴儿的风险调整后死亡率更高（优势比[OR]：2.38; 95％置信区间[CI] ]：1.81-3.13），中级重症监护病房（或：1.92; 95％CI：1.44-2.54）或小型（平均人口普查<15）社区重症监护病房（或：1.42; 95％CI：1.14-1.76）。与社区新生儿重症监护室（OR：1.11; 95％CI：0.87-1.43）相比，在社区（平均人口普查≥15）社区重症监护病房（NICU）出生的婴儿进行风险调整后的死亡率与统计学上的差异无统计学意义。除大型社区新生儿重症监护病房外，当数据仅限于体重<1500 g或体重<1250 g的婴儿时，所有这些OR较大，而体重在1250 g至1999 g和1500 g至1999 g的婴儿较小。对于大型社区NICU，对于较小的BW间隔，结果相似，并且仅对于较大的BW间隔才有意义。结论：这些结果支持以下建议：没有重症监护病房或中级重症监护病房的医院将估计胎儿体重<2000 g的高危母亲转移到区域性重症监护病房。对于体重<2000 g的婴儿，与没有NICU，任何规模的中级NICU或小型社区NICU的医院出生相比，在具有区域NICU的医院出生的患儿的风险调整后的死亡率较低。随后将新生儿转移到区域性重症监护病房仅能在一定程度上减少这些医院分娩的不利因素。少数具有大型社区重症监护病房的医院的证据好坏参半。尽管数据表明大型社区新生儿重症监护病房的死亡率较高，但尚无定论，还需要对大型社区新生儿重症监护病房的死亡率影响进行进一步研究。应当加大努力，在有重症监护病房的医院将预期体重<2000 g的婴儿分娩。

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