Delaney-Black V, Lubchenco L O, Butterfield L J, Goldson E, Koops B L, Lazotte D C
Department of Pediatrics, Wayne State University, Detroit, Michigan.
Am J Obstet Gynecol. 1989 Mar;160(3):545-52. doi: 10.1016/s0002-9378(89)80023-7.
Postnatal transfer of high-risk infants to a neonatal intensive care unit has been an accepted medical practice for more than two decades. More recently, antepartum maternal referral for the smallest infants has been recommended to reduce infant mortality, morbidity, and long-term handicaps. The limited data available to compare in utero and postnatal transfer suggest that maternal risk factors may also influence antenatal referral. We evaluated antepartum maternal and postnatal infant referrals from five metropolitan Denver hospitals with level I facilities. Mothers who were referred to the tertiary perinatal center before delivery were more likely to have one or more high-risk conditions. The presence of a maternal risk factor (preeclampsia, antepartum bleeding, prolonged rupture of the membranes, or chorioamnionitis) was significantly more common in the maternal transfer group (p less than 0.002). Neonatal weight was higher for the maternal referrals compared with neonatal referrals. Neonatal survival was independently improved by transport of mother or infant, increasing birth weight, and higher Apgar scores. We suggest that maternal risk factors were an important determinant in the choice of antenatal referral to our perinatal center for both the community and regional hospitals during this study period. Studies that compare outcome of infants after maternal and infant transfer must control for potentially inherent differences between the antenatally and postnatally transferred infants.
高危婴儿产后转至新生儿重症监护病房二十多年来一直是公认的医疗行为。最近，有人建议对最小的婴儿进行产前母亲转诊，以降低婴儿死亡率、发病率和长期残疾率。现有的有限数据用于比较宫内和产后转诊，结果表明母亲的危险因素也可能影响产前转诊。我们评估了丹佛市五家拥有一级设施的医院的产前母亲转诊和产后婴儿转诊情况。分娩前被转诊至三级围产期中心的母亲更有可能患有一种或多种高危病症。母亲转诊组中存在母亲危险因素（先兆子痫、产前出血、胎膜早破或绒毛膜羊膜炎）的情况明显更为常见（P<0.002）。与新生儿转诊相比，母亲转诊的新生儿体重更高。母亲或婴儿的转运、出生体重增加和阿氏评分较高可独立提高新生儿存活率。我们认为，在本研究期间，母亲危险因素是社区医院和地区医院选择将婴儿产前转诊至我们围产期中心的一个重要决定因素。比较母婴转诊后婴儿结局的研究必须控制产前和产后转诊婴儿之间可能存在的固有差异。
