Draper Elizabeth S, Zeitlin Jennifer, Field David J, Manktelow Bradley N, Truffert Patrick
Reader in Perinatal and Paediatric Epidemiology, Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, UK.
Arch Dis Child Fetal Neonatal Ed. 2007 Sep;92(5):F356-60. doi: 10.1136/adc.2006.097683. Epub 2007 Jan 9.
To explore the differences in outcome of very preterm pregnancies between two geographically defined populations in Europe with similar socioeconomic characteristics and healthcare provision but different organisational arrangements for perinatal care.
Prospective cohort study.
Nord Pas-de-Calais (NPC), France, and Trent, UK.
All pregnancy outcomes 22(+0) to 32(+6) weeks' gestational age for resident mothers.
Mortality patterns (antepartum death, intrapartum death, labour ward death and neonatal unit death) among very preterm babies were analysed by region. Multinomial logistic regression was used to model regional differences for a variety of pregnancy outcomes and to adjust for regional differences in the organisation of perinatal care.
Delivery of very preterm infants was significantly higher in Trent compared with NPC (1.9% v 1.5% of all births, respectively (p<0.001)). Stillbirth rate was significantly higher in NPC than in Trent (23.0%, 95% CI 20.0% to 26.5% v 14.4%, 95% CI 12.3% to 16.6%, respectively (p<0.001)) and survival to discharge was higher in Trent than in NPC (74.6%, 95% CI 71.9% to 77.1% v 66.7%, 95% CI 63.3% to 69.9%, respectively (p<0.001)). Probability of intrapartum and labour ward death in NPC was more than five times higher than Trent (relative risk 5.3, 95% CI 2.2 to 13.1 (p<0.001)).
The high rate of very preterm deliveries and the larger proportion of these infants recorded as live born in Trent appear to be the cause of the excess neonatal mortality seen in the routine statistics. Information about very preterm babies (not usually included in routine statistics) is vital to avoid inappropriate interpretation of international perinatal and infant data. This study highlights the importance of including deaths before transfer to neonatal care and emphasises the need to include the outcome of all pregnancies in a population in any comparative analysis.
探讨欧洲两个地理区域内社会经济特征和医疗保健服务相似，但围产期护理组织安排不同的极早产妊娠结局的差异。
前瞻性队列研究。
法国北部加来海峡大区（NPC）和英国特伦特地区。
常住母亲妊娠22（+0）至32（+6）周的所有妊娠结局。
按地区分析极早产婴儿的死亡模式（产前死亡、产时死亡、产房死亡和新生儿病房死亡）。采用多项逻辑回归对各种妊娠结局的地区差异进行建模，并对围产期护理组织的地区差异进行调整。
与NPC相比，特伦特地区极早产婴儿的分娩率显著更高（分别占所有出生婴儿的1.9%和1.5%，p<0.001）。NPC的死产率显著高于特伦特地区（分别为23.0%，95%可信区间20.0%至26.5%和14.4%，95%可信区间12.3%至16.6%，p<0.001），特伦特地区出院时的存活率高于NPC（分别为74.6%，95%可信区间71.9%至77.1%和66.7%，95%可信区间63.3%至69.9%，p<0.001）。NPC中产时和产房死亡的概率比特伦特地区高出五倍多（相对风险5.3，95%可信区间2.2至13.1，p<0.001）。
特伦特地区极高的极早产分娩率以及这些婴儿中较高比例的活产似乎是常规统计中新生儿死亡率过高的原因。极早产婴儿的信息（通常不包括在常规统计中）对于避免对国际围产期和婴儿数据的不当解读至关重要。本研究强调了纳入转至新生儿护理前死亡情况的重要性，并强调在任何比较分析中都需要纳入人群中所有妊娠的结局。
