极早产儿围产期干预的地区和种族差异。
Regional and Racial-Ethnic Differences in Perinatal Interventions Among Periviable Births.
机构信息
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; the Vermont Oxford Network, the Department of Mathematics and Statistics, University of Vermont, and the Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont; and the Department of Obstetrics & Gynecology, the University of Texas Medical Branch at Galveston, Galveston, Texas.
出版信息
Obstet Gynecol. 2020 Apr;135(4):885-895. doi: 10.1097/AOG.0000000000003747.
OBJECTIVE
To examine whether there are: 1) regional differences in three perinatal interventions that reflect active treatment among periviable gestations and 2) racial-ethnic differences in the receipt of these perinatal interventions after accounting for hospital region.
METHODS
We conducted a retrospective study on neonates born at 776 U.S. centers that participated in the Vermont Oxford Network (2006-2017) with a gestational age of 22-25 weeks. The primary outcome was postnatal life support. Secondary outcomes included maternal administration of antenatal corticosteroids and cesarean delivery. We examined rates and 99% CI of the three outcomes by region. We also calculated the adjusted relative risks (aRRs) and 99% CIs for the three outcomes by race and ethnicity within each region using modified Poisson regression models with robust variance estimation.
RESULTS
Major regional variation exists in the use of the three interventions at 22 and 23 weeks of gestation but not at 24 and 25 weeks. For example, at 22 weeks of gestation, rates of life support in the South (38.3%; 99% CI 36.3-40.2) and the Midwest (32.7%; 99% CI 30.4-35.0) were higher than in the Northeast (20.2%; 99% CI 17.6-22.8) and the West (22.2%; 99% CI 20.0-24.4). Particularly in the Northeast, black and Hispanic neonates born at 22 or 23 weeks of gestation had a higher provision of postnatal life support than white neonates (at 22 weeks: black: aRR 1.84 [99% CI 1.33-2.56], Hispanic: aRR 1.80 [1.23-2.64]; at 23 weeks: black: aRR 1.14 [99% CI 1.08-1.20], Hispanic: aRR 1.12 [1.05-1.19]). In the West, black and Hispanic neonates born at 23 weeks of gestation also had a higher provision of life support (black: aRR 1.11 [99% CI 1.03-1.19]; Hispanic: aRR 1.10 [1.04-1.16]).
CONCLUSION
Major regional variation exists in perinatal interventions when managing 22- and 23-week neonates. In the Northeast and the West regions, minority neonates born at 22 and 23 weeks of gestation had higher provision of postnatal life support.
目的
研究是否存在以下情况：1）极早产儿的三种围产期干预措施存在区域差异，这些措施反映了积极的治疗方法；2）在考虑医院区域的情况下，这些围产期干预措施的接受程度存在种族差异。
方法
我们对 2006 年至 2017 年期间在参与美国佛蒙特牛津网络（Vermont Oxford Network）的 776 个中心出生的胎龄为 22-25 周的新生儿进行了回顾性研究。主要结局为新生儿出生后的生命支持。次要结局包括产妇产前使用皮质类固醇和剖宫产。我们按区域检查了三种结局的发生率和 99%置信区间（CI）。我们还使用修正泊松回归模型和稳健方差估计，按种族和民族在每个区域内计算了三种结局的调整相对风险（aRR）和 99%CI。
结果
在 22 周和 23 周时，三种干预措施的使用存在明显的区域差异，但在 24 周和 25 周时则没有。例如，在 22 周时，南部（38.3%；99%CI 36.3-40.2）和中西部（32.7%；99%CI 30.4-35.0）的生命支持率高于东北部（20.2%；99%CI 17.6-22.8）和西部（22.2%；99%CI 20.0-24.4）。特别是在东北部，黑人婴儿和西班牙裔婴儿在 22 或 23 周时接受的产后生命支持率高于白人婴儿（22 周：黑人：aRR 1.84[99%CI 1.33-2.56]，西班牙裔：aRR 1.80[1.23-2.64]；23 周：黑人：aRR 1.14[99%CI 1.08-1.20]，西班牙裔：aRR 1.12[1.05-1.19]）。在西部，23 周时出生的黑人婴儿和西班牙裔婴儿也获得了更高的生命支持（黑人：aRR 1.11[99%CI 1.03-1.19]；西班牙裔：aRR 1.10[1.04-1.16]）。
结论
在管理 22-23 周龄新生儿时，围产期干预措施存在明显的区域差异。在东北部和西部，22 周和 23 周时出生的少数族裔婴儿获得了更高水平的产后生命支持。
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