Helenius Kjell, Helle Emmi, Lehtonen Liisa
Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Faculty of Medicine, University of Turku, Turku, Finland.
Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Stanford University, Cardiovascular Institute, Stanford, CA.
J Pediatr. 2016 Feb;169:81-6. doi: 10.1016/j.jpeds.2015.10.062. Epub 2015 Nov 18.
To evaluate the amount of antenatal care days in level III hospitals caused by regionalization of very preterm deliveries.
We included all 171,997 pregnancies registered in Finland between January 1, 2004 and December 31, 2006. Data on deliveries from the Medical Birth Register were linked to the Hospital Discharge Register. Maternal zip codes were used to define whether a mother lived inside or outside a level III hospital region. Regionalization was defined as care in level III hospitals between gestational weeks 22 and 32 among mothers living outside level III hospital regions. Pregnancies were divided into 3 groups based on the gestational age at delivery: very preterm (<32 weeks), late preterm (32-36 weeks), and term (≥37 weeks).
There were 12,354 antenatal care days in level III hospitals caused by regionalization, which amounts to a need for 12 antenatal maternal beds annually. In the very preterm pregnancies, the antenatal length of stay was comparable for mothers living inside or outside level III hospital regions (median 4 days, P = .81) but significantly longer for mothers living outside level III hospital regions in the late preterm (median 9 vs 7 days, P = .001) and term groups (median 3 vs 2 days, P < .0001).
The costs of regionalization of very preterm deliveries were low, as measured by antenatal care days. Regionalization did not increase the antenatal length of stay in very preterm deliveries.
评估极早产分娩区域化导致的三级医院产前护理天数。
我们纳入了2004年1月1日至2006年12月31日在芬兰登记的所有171,997例妊娠。医疗出生登记处的分娩数据与医院出院登记处相链接。产妇的邮政编码用于确定母亲是否居住在三级医院区域内。区域化定义为居住在三级医院区域外的母亲在妊娠22至32周期间在三级医院接受护理。根据分娩时的孕周将妊娠分为3组：极早产（<32周）、晚期早产（32 - 36周）和足月产（≥37周）。
区域化导致三级医院有12354个产前护理天数，这意味着每年需要12张产前产妇床位。在极早产妊娠中，居住在三级医院区域内或外的母亲产前住院时间相当（中位数4天，P = 0.81），但在晚期早产组（中位数9天对7天，P = 0.001）和足月产组（中位数3天对2天，P < 0.0001）中，居住在三级医院区域外的母亲产前住院时间明显更长。
以产前护理天数衡量，极早产分娩区域化的成本较低。区域化并未增加极早产分娩的产前住院时间。
