Department of Emergency Medicine, CHU Nantes, Nantes University Hospital, 44000, Nantes, France.
MiHAR lab, Université de Nantes, 44000, Nantes, France.
Scand J Trauma Resusc Emerg Med. 2019 Mar 2;27(1):26. doi: 10.1186/s13049-019-0600-z.
In France, while most babies are delivered at hospital, emergency medical services (EMS) weekly manage calls for unplanned out-of-hospital births. The objective of our study was to describe neonatal morbidity and mortality, defined as death or neonatal intensive care unit hospitalization at Day 7, in a prospective multicentric cohort of unplanned out-of-hospital births.
We prospectively analyzed out-of-hospital births from 25 prehospital EMS units in France. The primary outcome was neonatal morbidity and mortality, and the secondary outcome was risk factors associated with neonatal morbidity and mortality. A univariate logistic regression was first made, followed by a multivariate logistic regression with backward selection.
From October 2011 to August 2018, a total of 1670 unplanned out-of-hospital births were included. Of these, 1652 (99.2%) were singleton and 1537 (93.5%) had prenatal care. Maternal mean age of the study population was 30 ± 5.5 (range 15 to 48). The majority of women were multiparous, but 13% were nulliparous. Overall, 45.3% of these unplanned out-of-hospital births were medically-driven, either by phone during medical regulation (12.5%) or on scene by the prehospital emergency medical service units (32.9%). The prevalence of neonatal morbidity and mortality was 6.3% (n = 106) after an unplanned out-of-hospital birth (death before Day 7: n = 20; 1.2%). The multivariate logistic regression found that multiparity (adjusted Odds Ratio = 70.7 [4.7-1062]), prematurity (adjusted Odds Ratio = 6.7 [2.1-21.4]), maternal pathology (adjusted Odds Ratio = 2.8 [1.0-7.5]) and hypothermia (adjusted Odds Ratio = 2.8 [1.1-7.6]) were independent predictive factors of neonatal morbidity and mortality.
Our study assessed for the first time risk factors for adverse perinatal outcome in a large and multicenter cohort of unplanned out-of-hospital births. We have to improve temperature management in the out-of-hospital field and future trials are required to investigate strategies to optimize newborns management in the prehospital area.
在法国，尽管大多数婴儿都是在医院分娩的，但急救医疗服务机构每周都会处理非计划性的院外分娩的急救电话。本研究的目的是描述非计划性院外分娩的新生儿发病率和死亡率，即 7 天内死亡或新生儿重症监护病房住院。
我们前瞻性地分析了法国 25 个院前急救医疗服务机构的院外分娩。主要结局是新生儿发病率和死亡率，次要结局是与新生儿发病率和死亡率相关的危险因素。首先进行单因素逻辑回归，然后进行向后选择的多因素逻辑回归。
2011 年 10 月至 2018 年 8 月，共纳入 1670 例非计划性院外分娩。其中，1652 例（99.2%）为单胎，1537 例（93.5%）有产前检查。研究人群中产妇的平均年龄为 30±5.5（15-48）岁。大多数妇女是多产妇，但有 13%是初产妇。总的来说，这些非计划性院外分娩中有 45.3%是医疗驱动的，要么是在医疗监管期间通过电话（12.5%），要么是由院前急救医疗服务机构在现场（32.9%）。非计划性院外分娩后新生儿发病率和死亡率为 6.3%（n=106）（7 天前死亡：n=20；1.2%）。多因素逻辑回归发现，多胎（调整后的优势比=70.7[4.7-1062]）、早产（调整后的优势比=6.7[2.1-21.4]）、母体病理学（调整后的优势比=2.8[1.0-7.5]）和低体温（调整后的优势比=2.8[1.1-7.6]）是新生儿发病率和死亡率的独立预测因素。
我们的研究首次在一个大的、多中心的非计划性院外分娩队列中评估了不良围产结局的危险因素。我们必须改善院外领域的体温管理，未来的试验需要研究优化院前区域新生儿管理的策略。
