Arad Ilan, Braunstein Rony, Bar-Oz Benjamin
Department of Neonatology and Center for Safety and Quality, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Isr Med Assoc J. 2008 Jun;10(6):457-61.
A substantial number of premature deliveries occur in hospitals lacking neonatal intensive care facilities. We previously demonstrated a comparable outcome of very low birth weight infants delivered in a level II nursery to that of inborn infants delivered in our tertiary care center, but a similar comparison of extremely low birth weight infants has not been done.
To compare the neonatal outcome (mortality, severe intraventricular hemorrhage/periventricular leukomalacia, bronchopulmonary dysplasia and intact survival) of inborn and outborn ELBW infants, accounting for sociodemographic, obstetric and perinatal variables.
We compared 97 ELBW infants (birth weight < or = 1000 g) delivered between the years 2000 and 2004 in a hospital providing neonatal intensive care to 53 ELBW babies delivered in a referring hospital. A univariate model was first applied to examine the associations of the individual independent variables with the outcome variable, followed by a logistic stepwise regression analysis for each of the outcome variables. The odds ratios for each predictor were reported as well as their P values and 95% confidence intervals.
In the stepwise logistic regression analysis, accounting for a possible confounding effect of the independent variables, 'hospital of birth' remained a statistically significant predictor in the final step only for mortality, with odds ratio (inborns relative to outborns) of 3.32 (95% CI 1.19-9.28, P = 0.022). No statistically significant associations with the other outcome variables were found (severe IVH/PVL odds ratio = 1.99, 95% CI = 0.77-5.14, P = 0.155; BPD odds ratio = 0.60, 95% CI = 0.19-1.91, P= 0.384; intact survival OR = 0.56, 95% CI = 0.23-1.35, P = 0.195).
ELBW outborn infants may share an outcome comparable with that of inborn babies, if adequate perinatal care is provided.
大量早产发生在缺乏新生儿重症监护设施的医院。我们之前证明了在二级护理病房出生的极低出生体重儿与在我们三级护理中心出生的新生儿结局相当，但对于超低出生体重儿尚未进行类似比较。
比较出生时体重极低（ELBW）的院内和院外出生婴儿的新生儿结局（死亡率、严重脑室内出血/脑室周围白质软化、支气管肺发育不良和存活情况），同时考虑社会人口统计学、产科和围产期变量。
我们比较了2000年至2004年间在一家提供新生儿重症监护的医院出生的97例出生体重≤1000g的ELBW婴儿与在转诊医院出生的53例ELBW婴儿。首先应用单变量模型检查各个独立变量与结局变量之间的关联，然后对每个结局变量进行逻辑逐步回归分析。报告每个预测因素的比值比及其P值和95%置信区间。
在逐步逻辑回归分析中，考虑到独立变量可能的混杂效应，“出生医院”仅在最后一步对死亡率仍是具有统计学意义的预测因素，比值比（院内出生相对于院外出生）为3.32（95%CI 1.19 - 9.28，P = 0.022）。未发现与其他结局变量有统计学意义的关联（严重脑室内出血/脑室周围白质软化的比值比 = 1.99，95%CI = 0.77 - 5.14，P = 0.155；支气管肺发育不良的比值比 = 0.60，95%CI = 0.19 - 1.91，P = 0.384；存活情况的比值比 = 0.56，95%CI = 0.23 - 1.35，P = 0.195）。
如果提供足够的围产期护理，院外出生的ELBW婴儿可能与院内出生婴儿有相似的结局。
