Urato Adam C, Craigo Sabrina D, Chelmow David, O'Brien William F
Department of Obstetrics and Gynecology, University of South Florida/Tampa General Hospital, Tampa, FL, USA.
Am J Obstet Gynecol. 2006 Dec;195(6):1521-6. doi: 10.1016/j.ajog.2006.03.084. Epub 2006 May 24.
In obstetrics, the care of patients in labor or with emergencies takes place day and night. Birth-related injury is among the worst of obstetric outcomes. This study sought to examine the relationship between time of birth and fetal injury resulting in death.
The Birth-Related Neurologic Injury Compensation Association (NICA) is a Florida organization that pays for the care of infants >2500 g with birth-related brain or spinal cord injury resulting in permanent impairment. We conducted a case-control study using all deaths from the NICA database from 1989 to 2002. Data were collected on the antepartum, intrapartum, and postpartum care of the mother and fetus/child. Time of birth was identified for all cases and compared with a randomly selected control group of 1000 births in 1996 from Florida.
Eighty deaths were identified in the NICA database of 447 total cases. Of the 80 cases, 36/80 (45%) were born from 11 pm to 8 am. Of the 999 controls (1 certificate sealed for adoption) 281 (28.1%) were born from 11 pm to 8 am. This yields an odds ratio of 2.09 (95% CI 1.29-3.40) for the association of nighttime birth with fetal injury resulting in death.
Fetuses sustaining injuries resulting in death were more than twice as likely as controls to have been born from 11 pm to 8 am. Further studies are needed to determine the factors that affect this association and what changes might need to be made to optimize care regardless of time of day or night.
在产科领域，对分娩期或急诊患者的护理是全天候进行的。与分娩相关的损伤是最严重的产科结局之一。本研究旨在探讨出生时间与导致死亡的胎儿损伤之间的关系。
与分娩相关的神经损伤赔偿协会（NICA）是佛罗里达州的一个组织，为体重>2500g、因分娩相关脑或脊髓损伤导致永久性损伤的婴儿提供护理费用。我们使用1989年至2002年NICA数据库中的所有死亡病例进行了一项病例对照研究。收集了母亲和胎儿/儿童产前、产时和产后护理的数据。确定了所有病例的出生时间，并与1996年从佛罗里达州随机选取的1000例出生的对照组进行比较。
在NICA数据库的447例总病例中确定了80例死亡。在这80例病例中，36/80（45%）在晚上11点至上午8点出生。在999例对照组（1份证书因收养封存）中，281例（28.1%）在晚上11点至上午8点出生。这得出夜间出生与导致死亡的胎儿损伤之间的比值比为2.09（95%CI 1.29 - 3.40）。
因损伤导致死亡的胎儿在晚上11点至上午8点出生的可能性是对照组的两倍多。需要进一步研究以确定影响这种关联的因素，以及无论白天还是晚上都可能需要做出哪些改变以优化护理。
