Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Am J Obstet Gynecol. 2011 Nov;205(5):456.e1-6. doi: 10.1016/j.ajog.2011.08.007. Epub 2011 Aug 16.
We sought to determine the proportion of evidence-based (EB), vs non-EB (NEB) iatrogenic late preterm birth, and to compare corresponding rates of neonatal intensive care unit (NICU) admission.
We performed a retrospective cohort study. Cases were categorized as EB or NEB. NICU admission was compared between groups in both univariate and multivariate analysis.
Of 2693 late preterm deliveries, 32.3% (872/2693) were iatrogenic; 56.7% were delivered for NEB indications. Women with NEB deliveries were older (30.0 vs 28.6 years, P = .001), and more likely to be pregnant with twins (18.8% vs 7.9%, P < .001), have private insurance (80.3% vs 59.0%, P < .001), or have a second complicating factor (27.5% vs 10.1%, P < .001). A total of 56% of EB deliveries resulted in NICU admissions. After controlling for confounders, early gestational age (34 vs 36 weeks: odds ratio, 19.34; 95% confidence interval, 4.28-87.5) and mode of delivery (cesarean: odds ratio, 1.88; 95% confidence interval, 1.15-3.05) were most strongly associated with NICU admission.
Over half of nonspontaneous late preterm births were NEB. EB guidelines are needed.
我们旨在确定基于证据（EB）与非基于证据（NEB）医源性晚期早产儿分娩的比例，并比较相应的新生儿重症监护病房（NICU）入住率。
我们进行了一项回顾性队列研究。将病例分为 EB 或 NEB。在单变量和多变量分析中，比较两组之间的 NICU 入住率。
在 2693 例晚期早产儿分娩中，32.3%（872/2693）为医源性；56.7%因 NEB 指征分娩。NEB 分娩的产妇年龄更大（30.0 岁 vs 28.6 岁，P=0.001），更有可能怀双胞胎（18.8% vs 7.9%，P<0.001），有私人保险（80.3% vs 59.0%，P<0.001）或有第二个合并症因素（27.5% vs 10.1%，P<0.001）。共有 56%的 EB 分娩导致 NICU 入住。在控制混杂因素后，早期妊娠（34 周 vs 36 周：优势比，19.34；95%置信区间，4.28-87.5）和分娩方式（剖宫产：优势比，1.88；95%置信区间，1.15-3.05）与 NICU 入住率最密切相关。
超过一半的非自发性晚期早产儿分娩是 NEB。需要 EB 指南。
