Philopoulos D
Cabinet Philopoulos, 22, avenue de l'Observatoire, 75014 Paris, France.
J Gynecol Obstet Biol Reprod (Paris). 2015 May;44(5):451-62. doi: 10.1016/j.jgyn.2014.07.003. Epub 2014 Sep 16.
Sensitivity analysis of the association between electronic fetal monitoring and neonatal and infant mortality previously reported from a United States database.
Retrospective cohort study of 11,916,806 live births linked to neonatal and infant deaths during the years 1997-2002 from the United States Centers for Disease Control's National Center of Health Statistics (NCHS) linked birth and infant death data. Restrictions were performed to exclude deliveries occurring outside of a hospital, precipitous labors, breech deliveries, eleven risk factors of pregnancy, multiple gestations, deliveries before 24 and after 44 weeks, implausible birthweights, repeat cesarean sections, and congenital anomalies. An additional analysis explored the effect of further restrictions to term births, birth weight≥2500 g, absence of maternal fever (>38°C), and absence of labor induction or augmentation. For each year, adjusted relative risks (RR) were estimated with log binomial regression. A six-year pooled association was estimated by the generic inverse variance method using a random effects model.
For the six-year period, there was a significant reduction in risk in the group with electronic fetal monitoring for early neonatal mortality (RR=0.54, 95 % CI: 0.52-0.57), late neonatal mortality (RR=0.84, 95 % CI: 0.78-0.90), post-neonatal mortality (RR=0.86, 95 % CI: 0.83-0.90), and infant mortality from all causes (RR=0.75, 95 % CI: 0.73-0.77), from perinatal causes (RR=0.60, 95 % CI: 0.57-0.63), and from hypoxia (RR=0.67, 95 % CI: 0.54-0.84). In the additional analysis, which only examined the outcome of infant mortality from all causes, there was also a significant reduction in risk (RR=0.91, 95 % CI: 0.85-0.97).
Using the NCHS linked birth and infant death data over a 6-year period, electronic fetal monitoring was associated with decreased neonatal and infant mortality as has been previously reported. These results were robust to two levels of restriction applied on potential confounding variables.
对先前从美国数据库报告的电子胎儿监护与新生儿及婴儿死亡率之间的关联进行敏感性分析。
对1997年至2002年间美国疾病控制中心国家卫生统计中心（NCHS）链接的出生与婴儿死亡数据中的11,916,806例活产进行回顾性队列研究。进行了限制以排除在医院外发生的分娩、急产、臀位分娩、11种妊娠风险因素、多胎妊娠、24周前和44周后的分娩、不合理的出生体重、重复剖宫产以及先天性异常。另一项分析探讨了进一步限制为足月分娩、出生体重≥2500克、无母体发热（>38°C）以及无引产或催产的影响。每年，使用对数二项回归估计调整后的相对风险（RR）。采用随机效应模型，通过通用逆方差法估计六年的合并关联。
在六年期间，进行电子胎儿监护的组中，早期新生儿死亡率（RR = 0.54，95%CI：0.52 - 0.57）、晚期新生儿死亡率（RR = 0.84，95%CI：0.78 - 0.90）、新生儿后期死亡率（RR = 0.86，95%CI：0.83 - 0.90）以及所有原因导致的婴儿死亡率（RR = 0.75，95%CI：0.73 - 0.77）、围产期原因导致的婴儿死亡率（RR = 0.60，95%CI：0.57 - 0.63）和缺氧导致的婴儿死亡率（RR = 0.67，95%CI：0.54 - 0.84）的风险均显著降低。在仅检查所有原因导致的婴儿死亡率结果的另一项分析中，风险也显著降低（RR = 0.91，95%CI：0.85 - 0.97）。
使用NCHS六年期间链接的出生与婴儿死亡数据，电子胎儿监护与新生儿及婴儿死亡率降低相关，如先前报道。这些结果对应用于潜在混杂变量的两个限制水平具有稳健性。
