Gibbs L, Tooke L, Harrison M C
Department of Neonatology, Groote Schuur Hospital, Cape Town; School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2017 Sep 22;107(10):900-903. doi: 10.7196/SAMJ.2017.v107i10.12463.
The Groote Schuur Hospital (GSH) neonatal nursery provides level 3 care for the Metro West Health District in the Western Cape Province of South Africa. Worldwide, very-low-birth-weight (VLBW) neonates delivered in level 3 neonatal units have better outcomes than those transported from other facilities.
To identify the characteristics and outcomes of VLBW neonates at GSH, with emphasis on differences between inborns and outborns.
This was a retrospective cohort study. VLBW neonates admitted to the GSH neonatal nursery between 1 January 2012 and 31 December 2013 were enrolled on the Vermont Oxford Network database and reviewed.
Of 1 032 VLBW neonates enrolled, 906 (87.8%) were delivered at GSH and 126 (12.2%) were outborn. Access to antenatal care, antenatal steroids and inborn status were statistically significant predictors of mortality and survival without morbidity. The mothers of inborn patients were more likely than those of outborn patients to have received antenatal care (89.1% v. 57.9%; p<0.0001) and antenatal steroids (64.2% v. 15.2%; p<0.0001). Inborns required less ventilatory support (16.2% v. 57.9%; p<0.0001) and surfactant administration than outborns (25.3% v. 65.1%; p<0.0001), and developed less late infection (8.8% v. 23.4%; p<0.0001), severe intraventricular haemorrhage (3.7% v. 13.9%; p<0.0001) and chronic lung disease (5.3% v. 13.4%; p=0.003). The incidence of necrotising enterocolitis was similar in the two groups (5.9% v. 8.7%; p=0.227). The mortality rate was 18.4% for inborns and 33.3% for outborns (p<0.0001). Mortality declined as birth weight increased. Of the survivors, 85.0% of inborns and 70.2% of outborns did not develop serious morbidity (p=0.003).
VLBW neonates delivered at GSH had better outcomes than their outborn counterparts. Perinatal regionalisation is beneficial to our patients, with antenatal care, timeous transfer in utero and antenatal steroids contributing to excellent outcomes.
格罗特舒尔医院（GSH）新生儿重症监护室为南非西开普省都市西区提供三级护理服务。在全球范围内，在三级新生儿重症监护病房出生的极低出生体重（VLBW）新生儿比从其他机构转运来的新生儿预后更好。
确定GSH医院VLBW新生儿的特征和预后，重点关注本地出生和外地转入出生新生儿之间的差异。
这是一项回顾性队列研究。纳入2012年1月1日至2013年12月31日期间入住GSH新生儿重症监护室的VLBW新生儿，并录入佛蒙特牛津网络数据库进行分析。
在纳入的1032例VLBW新生儿中，906例（87.8%）在GSH医院出生，126例（12.2%）为外地转入出生。获得产前护理、产前使用类固醇激素以及本地出生状态是死亡率和无并发症存活的统计学显著预测因素。本地出生患儿的母亲比外地转入出生患儿的母亲更有可能接受产前护理（89.1%对57.9%；p<0.0001）和产前使用类固醇激素（64.2%对15.2%；p<0.0001）。本地出生患儿比外地转入出生患儿需要更少的通气支持（16.2%对57.9%；p<0.0001）和表面活性剂治疗（25.3%对65.1%；p<0.0001），发生晚期感染（8.8%对23.4%；p<0.0001）、重度脑室内出血（3.7%对13.9%；p<0.0001）和慢性肺病（5.3%对13.4%；p=0.003）的情况也更少。两组坏死性小肠结肠炎的发生率相似（5.9%对8.7%；p=0.227）。本地出生患儿的死亡率为18.4%，外地转入出生患儿的死亡率为33.3%（p<0.0001）。死亡率随出生体重增加而降低。在存活者中，85.0%的本地出生患儿和70.2%的外地转入出生患儿未发生严重并发症（p=0.003）。
在GSH医院出生的VLBW新生儿比外地转入出生的新生儿预后更好。围产期区域化对我们的患者有益，产前护理、适时的宫内转运和产前使用类固醇激素有助于取得良好的预后。
