Division of Neonatology, Department of Paediatrics, University of Limerick School of Medicine, Limerick, Ireland
Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick (UMHL), Limerick, Ireland.
BMJ Glob Health. 2020 Sep;5(9). doi: 10.1136/bmjgh-2020-003075.
Aetiology of births involving very low birthweight (VLBW) and extremely low birthweight (ELBW) infants is heterogeneous and preventive strategies remain elusive. Socioenvironmental measures implemented as Ireland's response to the SARS-CoV-2 virus (COVID-19) pandemic represented a national lockdown, and have possibly influenced the health and well-being of pregnant women and unborn infants.
Regional trends of VLBW and ELBW infants in one designated health area of Ireland over two decades were analysed. Poisson regression and rate ratio analyses with 95% CI were conducted. Regional data covering most of the lockdown period of 2020 were compared with historical regional and national data and forecasted national figures for 2020.
Poisson regression analysis found that the regional historical VLBW rate per 1000 live births for January to April, 2001-2019 was 8.18 (95% CI 7.21 to 9.29). During January to April 2020, an unusually low VLBW rate of just 2.17 per 1000 live births was observed, reflecting a rate ratio of 3.77 (95% CI 1.21 to 11.75), p=0.022, representing a 73% reduction of VLBW during the first 4 months of 2020 compared with same period for the preceding two decades. There were no ELBW infants admitted to the regional neonatal intensive care unit. National Irish VLBW rate for 2020 is forecasted to be reduced to approximate 400 per 60 000 births compared with the historical 500-600 range.
An unprecedented reduction in regional births of VLBW and ELBW infants was observed in Ireland coinciding with the COVID-19 lockdown. Potential determinants of this unique temporal trend possibly reside in the summative socioenvironmental impact of the COVID-19 lockdown. Our findings, if mirrored in other regions that have adopted a lockdown, demonstrate the potential to evaluate these implicated behavioural and socioenvironmental modifiers to positively influence VLBW and ELBW rates globally.
极低出生体重（VLBW）和超低出生体重（ELBW）婴儿的病因学具有异质性，预防策略仍难以捉摸。爱尔兰应对严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2，即新冠病毒）大流行而实施的社会环境措施代表了全国性封锁，这可能影响了孕妇和胎儿的健康和福祉。
分析了爱尔兰一个指定卫生区域 20 年来 VLBW 和 ELBW 婴儿的区域趋势。采用 Poisson 回归和率比分析，置信区间为 95%。对 2020 年大部分封锁期间的区域数据与历史区域和国家数据进行了比较，并对 2020 年的全国预测数据进行了比较。
Poisson 回归分析发现，2001 年至 2019 年 1 月至 4 月，每 1000 例活产儿中历史上的区域 VLBW 发生率为 8.18（95%CI 7.21-9.29）。在 2020 年 1 月至 4 月期间，观察到非常低的 VLBW 发生率仅为每 1000 例活产儿 2.17 例，这反映了率比为 3.77（95%CI 1.21-11.75），p=0.022，这意味着与过去 20 年同期相比，2020 年 1 月至 4 月期间 VLBW 减少了 73%。该地区新生儿重症监护病房没有收治 ELBW 婴儿。预计 2020 年爱尔兰全国 VLBW 发生率将降至每 6 万例出生约 400 例，而历史范围为 500-600 例。
爱尔兰观察到 VLBW 和 ELBW 婴儿的区域出生人数出现了前所未有的下降，这与 COVID-19 封锁 coinciding。这种独特的时间趋势的潜在决定因素可能在于 COVID-19 封锁的累积社会环境影响。如果其他采取封锁措施的地区也出现这种情况，我们的发现表明有可能评估这些涉及的行为和社会环境修饰剂，以积极影响全球的 VLBW 和 ELBW 率。
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