Mori Rintaro, Fujimura Masanori, Shiraishi Jun, Evans Beti, Corkett Michael, Negishi Hirokuni, Doyle Pat
National Collaborating Centre for Women's and Children's Health, London, UK.
Pediatr Int. 2007 Aug;49(4):452-8. doi: 10.1111/j.1442-200X.2007.02393.x.
Regionalization of perinatal health services has been actively discussed, although important determinants such as effect of duration of neonatal transport on neonatal outcomes have not been investigated well as yet. Therefore the purpose of the present paper was to investigate the association between duration of inter-facility transport and perinatal mortality.
For the systematic review, six major databases were searched. Any comparative studies investigating associations between duration of inter-facility neonatal transport and their outcomes, published in the English language were selected. The studies were screened and reviewed by two independent researchers. For the cohort study, study subjects included every neonate transported to neonatal wards in Osaka, Japan between 1980 and 2000 in an existing surveillance called Neonatal Mutual Cooperative System. They are followed up until 28 days of age, or discharge if earlier. Other variables were also considered as effect modifiers or confounders, including calendar year, birthweight (BW), gestational age (GA), sex, maternal/paternal age, Apgar scores at 1 and 5 min, place of birth and personnel accompanying the neonate during transport (transport personnel), body temperature before transport and on admission, severity of illness, and intraventricular hemorrhage (IVH) grade. Cox regression analyses were performed to obtain principal results, and sensitivity analysis to support them.
Systematic review: only one cross-sectional study conducted in an urban area in India was identified. That study showed that neonates with a long duration of transport had 79% higher odds of death than those transported for a short duration after adjusting for the confounding effects. For the cohort study, among 16 429 subjects, full data were available for 4966 neonates. There was strong evidence that those transported for >90 min had more than twice the rate of neonatal death (rate ratio [RR] 2.26, 95% confidence interval [CI]: 1.26-4.04), and some evidence that those transported for between 60 and 89 min had an 80% higher rate of neonatal death (RR 1.81, 95%CI: 1.07-3.06), both compared with those transported for between 30 and 59 min, after adjusting for the confounding effects. A sensitivity analysis on missing values also supported the results.
There is evidence of an association between duration of transport and increased neonatal mortality, which can be applied to organization of perinatal health services. A prospective cohort study is needed for further investigation.
围产期保健服务的区域化一直是人们积极讨论的话题，尽管诸如新生儿转运时长对新生儿结局的影响等重要决定因素尚未得到充分研究。因此，本文旨在探讨医疗机构间转运时长与围产期死亡率之间的关联。
为进行系统评价，检索了六个主要数据库。选取了所有以英文发表的、调查医疗机构间新生儿转运时长与其结局之间关联的比较研究。由两名独立研究人员对这些研究进行筛选和评审。对于队列研究，研究对象包括1980年至2000年间在日本大阪通过现有的新生儿互助合作系统监测被转运至新生儿病房的每一例新生儿。对他们进行随访直至28日龄，若提前出院则随访至出院时。还将其他变量视为效应修饰因素或混杂因素，包括日历年、出生体重（BW）、胎龄（GA）、性别、产妇/父亲年龄、1分钟和5分钟时的阿氏评分、出生地点以及转运期间陪伴新生儿的人员（转运人员）、转运前和入院时的体温、疾病严重程度以及脑室内出血（IVH）分级。进行Cox回归分析以获得主要结果，并进行敏感性分析以支持这些结果。
系统评价：仅识别出一项在印度某城市地区开展的横断面研究。该研究表明，在调整混杂效应后，转运时间长的新生儿死亡几率比转运时间短的新生儿高79%。对于队列研究，在16429名研究对象中，有4966例新生儿可获得完整数据。有强有力的证据表明，转运时间超过90分钟的新生儿死亡率是转运时间在30至59分钟之间新生儿的两倍多（率比[RR]2.26，95%置信区间[CI]：1.26 - 4.04），并且有一些证据表明，转运时间在60至89分钟之间的新生儿死亡率比转运时间在30至59分钟之间的新生儿高80%（RR 1.81，95%CI：1.07 - 3.06），这两种情况均在调整混杂效应后得出。对缺失值的敏感性分析也支持了这些结果。
有证据表明转运时长与新生儿死亡率增加之间存在关联，这可应用于围产期保健服务的组织安排。需要进行前瞻性队列研究以作进一步调查。
