Field D, Draper E S
Department of Epidemiology and Public Health, University of Leicester.
Arch Dis Child Fetal Neonatal Ed. 1999 Mar;80(2):F111-4. doi: 10.1136/fn.80.2.f111.
To compare the survival of premature infants, adjusted for disease severity, in different types of neonatal intensive care setting.
A prospective observational study in the Trent Health Region was carried out of all infants born to resident mothers at or before 32 weeks of gestation between 1 January 1994 to 31 December 1996 inclusive. The 16 neonatal units in Trent were subdivided into five relatively large units which regularly took outside referrals and 11 smaller units which provided intensive care for a variable proportion (sometimes nearly 100%) of their local population. Data regarding obstetric management, neonatal care, and outcome were collected by independent neonatal nurses who visited the units on a regular basis. Survival rates were compared with an expected rate calculated using the Clinical Risk Index for Babies (CRIB). For either setting to be abnormally good or bad actual deaths had to exceed the 95% confidence interval of the CRIB estimate.
Actual survival rates for infants < or = 32 weeks gestation and for the group of babies < or = 28 weeks gestation fell within the 95% confidence interval of the rate predicted by CRIB for both the larger referral units and the smaller district units. Similarly, compared with the CRIB prediction, infants transferred in utero or postnatally were not adversely affected in terms of the number who died.
Previous results from this geographical population, showing that survival of babies < or = 28 weeks gestation was better when their care was provided by referral units, are no longer sustained. Significant changes to the neonatal services over time make the current results plausible. However, the new structure poses potential threats to the teaching, training, and research base of the neonatal service as a whole.
比较不同类型新生儿重症监护环境下经疾病严重程度调整后的早产儿存活率。
对1994年1月1日至1996年12月31日（含）在特伦特健康地区居住的母亲所生的所有孕32周及以前出生的婴儿进行前瞻性观察研究。特伦特地区的16个新生儿病房被分为5个相对较大的、定期接收外部转诊的病房，以及11个较小的、为当地不同比例（有时接近100%）的人群提供重症监护的病房。关于产科管理、新生儿护理和结局的数据由独立的新生儿护士定期走访各病房收集。将存活率与使用婴儿临床风险指数（CRIB）计算出的预期率进行比较。若任一环境的实际死亡率超出CRIB估计值的95%置信区间，则认为该环境异常良好或异常恶劣。
孕周≤32周的婴儿以及孕周≤28周的婴儿组的实际存活率，在较大转诊病房和较小区域病房中均落在CRIB预测率的95%置信区间内。同样，与CRIB预测相比，宫内或出生后转诊的婴儿在死亡人数方面未受到不利影响。
该地理区域先前的研究结果显示，孕周≤28周的婴儿由转诊病房护理时存活率更高，但这一结果不再成立。随着时间推移，新生儿服务发生了重大变化，使得当前结果具有合理性。然而，新结构对整个新生儿服务的教学、培训和研究基础构成了潜在威胁。
