Division of Life-Course Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Arch Dis Child Fetal Neonatal Ed. 2018 May;103(3):F202-F207. doi: 10.1136/archdischild-2017-312635. Epub 2017 Aug 28.
Guidelines recommend individual decision making on resuscitating infants of 22-24 weeks' gestational age (GA) at birth. When the decision not to resuscitate is made, infants would likely die soon after delivery, and under some circumstances such neonatal deaths may be registered as stillbirths occurring during delivery (intrapartum stillbirth). Thus we assessed whether socioeconomic factors are associated with peridelivery deaths (during or within 1 hour of delivery) of infants delivered at 22-24 weeks' gestation.
We analysed 14 726 singletons of 22-24 weeks' GA using the 2003-2011 Japanese vital statistics, and assessed how maternal characteristics influence risk of peridelivery death as well as intrauterine fetal death (IUFD) and death after 1 hour of age until 40 weeks postmenstrual age.
Living in a municipality with low-average income (lowest tertile (risk ratio 1.32, 95% CI 1.20 to 1.44), middle tertile (risk ratio 1.08, 95% CI 0.98 to 1.19)), younger maternal age (age <20 (risk ratio 1.43, 95% CI 1.17 to 1.75), age 20-34 (risk ratio 1.14, 95% CI 1.03 to 1.27)) and having previous live births (risk ratio 1.08, 95% CI 1.01 to 1.17) increased risk of peridelivery deaths, but did not increase risk of IUFD or deaths after 1 hour of age. Peridelivery death was twice as likely to occur in births to multiparous teenage mothers in a low-income municipality, compared with those of older primiparous mothers in a wealthier municipality.
Socioeconomic factors substantially influence whether births of 22-24 weeks' GA survive delivery and the first hour of life. Such disparities may reflect the impact of socioeconomic situations on decision making for resuscitation.
指南建议在出生时对孕 22-24 周的婴儿进行单独的复苏决策。当决定不复苏时，婴儿很可能在分娩后不久死亡，在某些情况下，这种新生儿死亡可能被登记为分娩期间（产时）发生的死产。因此，我们评估了社会经济因素是否与孕 22-24 周出生婴儿的围产期死亡（分娩期间或分娩后 1 小时内）有关。
我们使用 2003-2011 年日本生命统计数据，对 14726 名孕 22-24 周的单胎婴儿进行了分析，并评估了产妇特征如何影响围产期死亡的风险，以及宫内胎儿死亡（IUFD）和出生后 1 小时至 40 周龄的死亡风险。
生活在低平均收入的市町村（收入最低的三分位（风险比 1.32，95%可信区间 1.20 至 1.44），中等三分位（风险比 1.08，95%可信区间 0.98 至 1.19））、产妇年龄较小（年龄<20 岁（风险比 1.43，95%可信区间 1.17 至 1.75），年龄 20-34 岁（风险比 1.14，95%可信区间 1.03 至 1.27））和有既往活产史（风险比 1.08，95%可信区间 1.01 至 1.17））增加了围产期死亡的风险，但不会增加 IUFD 或出生后 1 小时后的死亡风险。与较富裕市町村较年长的初产妇相比，来自低收入市町村的多胎青少年产妇的围产期死亡风险是前者的两倍。
社会经济因素对孕 22-24 周出生婴儿能否存活至分娩和出生后 1 小时有很大影响。这些差异可能反映了社会经济状况对复苏决策的影响。
