Lui Kei, Abdel-Latif Mohamed E, Allgood Catherine L, Bajuk Barbara, Oei Julee, Berry Andrew, Henderson-Smart David
Department of Newborn Care, Royal Hospital for Women, Barker St, Randwick, NSW 2031, Australia.
Pediatrics. 2006 Nov;118(5):2076-83. doi: 10.1542/peds.2006-1540.
The goal was to evaluate the impact of statewide coordinated changes in perinatal support and retrieval services on the outcomes of extremely premature births occurring outside perinatal centers in the state of New South Wales, Australia.
The intervention included additional, network-coordinated, perinatal telephone advice to optimize in utero transfers and centralization of the neonatal retrieval system, with preferential admission of retrieved infants (outborn infants) to perinatal centers instead of freestanding pediatric hospitals, from the middle of 1995. Population birth and NICU admission cohorts of infants of 23 to 28 weeks of gestation were studied. Outcomes of epoch 1 (1992 to the middle of 1995; 1778 births and 1100 NICU admissions) were compared with those of epoch 2 (1997-2002; 3099 births and 2100 NICU admissions), after an 18-month washout period.
There were 25% fewer nontertiary hospital live births (19.7% vs 14.9%) and more prenatal steroid use. Despite an 11.4% average annual increase in NICU admissions between the 2 epochs, fewer infants were outborn (12.0% vs 9.3%) and outborn mortality rates decreased significantly (39.4% vs 25.1%), particularly for those between 27 and 28 weeks of gestation. The overall improvement was equivalent to 1 extra survivor per 16 New South Wales births. There were also significantly fewer serious outcome morbidities in outborn infants during epoch 2, over the improvements in inborn infants.
Statewide coordinated strategies in reducing nontertiary hospital births and optimizing transport of outborn infants to perinatal centers have improved considerably the outcomes of extremely premature infants. These findings have vital implications for health outcomes and resource planning.
评估澳大利亚新南威尔士州全州围产期支持和转运服务的协调变化对该州围产期中心以外发生的极早产结局的影响。
干预措施包括额外的、网络协调的围产期电话咨询，以优化宫内转运和新生儿转运系统的集中化，自1995年年中起，优先将转运来的婴儿（外出生婴儿）收治到围产期中心而非独立的儿科医院。对妊娠23至28周婴儿的总体出生人群和新生儿重症监护病房（NICU）入院队列进行了研究。在18个月的洗脱期后，将第1阶段（1992年至1995年年中；1778例出生和1100例NICU入院）的结局与第2阶段（1997 - 2002年；3099例出生和2100例NICU入院）的结局进行比较。
非三级医院的活产数减少了25%（19.7%对14.9%），产前类固醇使用增加。尽管两个阶段之间NICU入院人数平均每年增加11.4%，但外出生婴儿数量减少（12.0%对9.3%），外出生婴儿死亡率显著下降（39.4%对25.1%），尤其是妊娠27至28周的婴儿。总体改善相当于每16例新南威尔士州出生婴儿多1名幸存者。与出生时即入院的婴儿相比，第2阶段外出生婴儿的严重结局发病率也显著降低。
全州范围内减少非三级医院分娩并优化外出生婴儿转运至围产期中心的协调策略，显著改善了极早产婴儿的结局。这些发现对健康结局和资源规划具有重要意义。
