Dumpa Vikramaditya, Avulakunta Indira, Shelton James, Yu Taechin, Lakshminrusimha Satyan
1Division of Neonatology, Department of Pediatrics, NYU Winthrop Hospital, 259 First St, Mineola, New York, 11501 USA.
Department of Pediatrics, Brookdale University Hospital and Medical, 1 Brookdale Plaza, Brooklyn, New York, 11212 USA.
Matern Health Neonatol Perinatol. 2019 Dec 5;5:19. doi: 10.1186/s40748-019-0114-8. eCollection 2019.
Elective delivery prior to term gestation is associated with adverse neonatal outcomes. The impact of American College of Obstetricians and Gynecologists (ACOG) guidelines recommending against induction of labor (IOL) < 39 weeks' postmenstrual age (PMA) on the frequency of early-term births and NICU admissions in Erie County, NY was evaluated in this study.
This is a population-based retrospective comparison of all live births and NICU admissions in Erie County, NY between pre-and post-ACOG IOL guideline epochs (2005-2008 vs. 2011-2014). Information on early-term, full/late/post-term births and NICU admissions was obtained. A detailed chart analysis of indications for admission to the Regional Perinatal Center was performed.
During the 2005-2008 epoch, early-term births constituted 27% (11,968/44,617) of live births. The NICU admission rate was higher for early-term births (1134/11968 = 9.5%) compared to full/late/post-term (1493/27541 = 5.4%).In the 2011-2014 epoch, early-term births decreased to 23% (10,286/44,575) of live births. However, NICU admissions for early-term (1072/10286 = 10.4%) and full/late/post-term births (1892/29508 = 6.4%) did not decrease partly due to asymptomatic infants exposed to maternal chorioamnionitis admitted for empiric antibiotic therapy as per revised early-onset sepsis guidelines.
ACOG recommendations against elective IOL or cesarean delivery < 39 weeks PMA were rapidly translated to clinical practice and decreased early-term births in Erie County, NY. This decrease did not translate to reduced NICU admissions partly due to increased NICU admissions for empiric antibiotic therapy.
足月前择期分娩与不良新生儿结局相关。本研究评估了美国妇产科医师学会（ACOG）关于不建议在月经龄（PMA）小于39周时引产（IOL）的指南对纽约州伊利县早期足月分娩频率和新生儿重症监护病房（NICU）入院率的影响。
这是一项基于人群的回顾性比较研究，对比了纽约州伊利县ACOG引产指南发布前后（2005 - 2008年与2011 - 2014年）所有活产和NICU入院情况。获取了关于早期足月、足月/晚期/过期产以及NICU入院的信息。对区域围产期中心的入院指征进行了详细的图表分析。
在2005 - 2008年期间，早期足月分娩占活产的27%（11,968/44,617）。早期足月分娩的NICU入院率（1134/11968 = 9.5%）高于足月/晚期/过期产（1493/27541 = 5.4%）。在2011 - 2014年期间，早期足月分娩降至活产的23%（10,286/44,575）。然而，早期足月分娩（1072/10286 = 10.4%）和足月/晚期/过期产（1892/29508 = 6.4%）的NICU入院率并未下降，部分原因是根据修订的早发型败血症指南，因暴露于母体绒毛膜羊膜炎的无症状婴儿接受经验性抗生素治疗而入院。
ACOG关于不建议在PMA小于39周时进行择期引产或剖宫产的建议迅速转化为临床实践，并降低了纽约州伊利县的早期足月分娩率。这种下降并未转化为NICU入院率的降低，部分原因是经验性抗生素治疗导致NICU入院率增加。
