Gould Jeffrey B, Marks Amy R, Chavez Gilberto
University of California-Berkeley, Berkeley, CA 94720, USA.
J Perinatol. 2002 Dec;22(8):630-40. doi: 10.1038/sj.jp.7210824.
In California, hospitals with Community Neonatal Intensive Care Units (NICUs) increased from 17 in 1990 to 52 in 1997. The purpose of this study was to investigate the effects of their growth on level-specific distribution of births, acuity, and neonatal mortality.
A total of 4,563,900 infants born from 1990 to 1997 were analyzed by levels of care. We examined shifts in birth location and acuity. Neonatal mortality for singleton very-low-birth-weight (VLBW) infants without congenital abnormalities was used to assess differences in level-specific survival.
Live births at hospitals with Community NICUs increased from 8.6% to 28.6%, and VLBW births increased from 11.7% to 37.4%. Births and VLBW births at Regional NICUs decreased, whereas acuity was unchanged. There were no differences in neonatal mortality of VLBW infants born at Community or Regional NICU hospitals. Mortality for VLBW births at other levels of care was significantly higher.
The rapid growth of monitored Community NICUs supported by a regionalized system of neonatal transport represents an evolving face of regionalization. Survival of VLBW births was similar at Community and Regional hospitals and higher than in other birth settings. Reducing VLBW births at Primary Care and Intermediate NICU hospitals continues to be an important goal of regionalization. doi:10.1038/sj.jp.7210824
在加利福尼亚州，设有社区新生儿重症监护病房（NICU）的医院数量从1990年的17家增加到了1997年的52家。本研究的目的是调查其增长对不同级别分娩分布、病情严重程度及新生儿死亡率的影响。
对1990年至1997年出生的4563900名婴儿按护理级别进行分析。我们研究了分娩地点和病情严重程度的变化。对无先天性异常的单胎极低出生体重（VLBW）婴儿的新生儿死亡率进行评估，以分析不同级别护理下的生存差异。
设有社区NICU的医院的活产率从8.6%增至28.6%，VLBW婴儿出生率从11.7%增至37.4%。区域NICU的分娩和VLBW婴儿出生率下降，而病情严重程度未变。在社区或区域NICU医院出生的VLBW婴儿的新生儿死亡率无差异。其他护理级别的VLBW婴儿出生率的死亡率显著更高。
由区域化新生儿转运系统支持的社区NICU的快速增长代表了区域化的一种发展态势。社区和区域医院中VLBW婴儿的存活率相似，且高于其他分娩环境。降低初级护理和中级NICU医院的VLBW婴儿出生率仍然是区域化的一个重要目标。doi:10.1038/sj.jp.7210824
