National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
Oliver Fisher Neonatal Intensive Care Unit, Medway Maritime Hospital, Medway NHS Foundation Trust, Gillingham, Kent, UK.
Arch Dis Child Fetal Neonatal Ed. 2021 Mar;106(2):194-203. doi: 10.1136/archdischild-2020-319099. Epub 2020 Oct 30.
To determine the incidence of and risk factors for neonatal unit admission, intrapartum stillbirth or neonatal death without admission, and describe outcomes, in babies born in an alongside midwifery unit (AMU).
National population-based case-control study.
We used the UK Midwifery Study System to identify and collect data about 1041 women who gave birth in AMUs, March 2017 to February 2018, whose babies were admitted to a neonatal unit or died (cases) and 1984 controls from the same AMUs. We used multivariable logistic regression, generating adjusted OR (aOR) with 95% CIs, to investigate maternal and intrapartum factors associated with neonatal admission or mortality.
The incidence of neonatal admission or mortality following birth in an AMU was 1.2%, comprising neonatal admission (1.2%) and mortality (0.01%). White 'other' ethnicity (aOR=1.28; 95% CI=1.01 to 1.63); nulliparity (aOR=2.09; 95% CI=1.78 to 2.45); ≥2 previous pregnancies ≥24 weeks' gestation (aOR=1.38; 95% CI=1.10 to 1.74); male sex (aOR=1.46; 95% CI=1.23 to 1.75); maternal pregnancy problem (aOR=1.40; 95% CI=1.03 to 1.90); prolonged (aOR=1.42; 95% CI=1.01 to 2.01) or unrecorded (aOR=1.38; 95% CI=1.05 to 1.81) second stage duration; opiate use (aOR=1.31; 95% CI=1.02 to 1.68); shoulder dystocia (aOR=5.06; 95% CI=3.00 to 8.52); birth weight <2500 g (aOR=4.12; 95% CI=1.97 to 8.60), 4000-4999 g (aOR=1.64; 95% CI=1.25 to 2.14) and ≥4500 g (aOR=2.10; 95% CI=1.17 to 3.76), were independently associated with neonatal admission or mortality. Among babies admitted (n=1038), 18% received intensive care. Nine babies died, six following neonatal admission. Sepsis (52%) and respiratory distress (42%) were the most common discharge diagnoses.
The results of this study are in line with other evidence on risk factors for neonatal admission, and reassuring in terms of the quality and safety of care in AMUs.
确定在旁助产单位（AMU）分娩的婴儿中，新生儿病房入院、产程中死产或新生儿死亡而无需入院的发生率和风险因素，并描述结局。
全国基于人群的病例对照研究。
我们使用英国助产士研究系统，于 2017 年 3 月至 2018 年 2 月期间，确定并收集了 1041 名在 AMU 分娩的妇女及其婴儿的数据，这些婴儿入住了新生儿病房或死亡（病例），并从同一 AMU 中随机抽取了 1984 名对照。我们使用多变量逻辑回归，生成调整后的优势比（aOR）及其 95%置信区间（CI），以调查与新生儿入院或死亡相关的产妇和产程因素。
在 AMU 分娩后，新生儿入院或死亡的发生率为 1.2%，包括新生儿入院（1.2%）和死亡（0.01%）。白人“其他”种族（aOR=1.28；95%CI=1.01 至 1.63）；初产妇（aOR=2.09；95%CI=1.78 至 2.45）；≥2 次妊娠≥24 周（aOR=1.38；95%CI=1.10 至 1.74）；男性（aOR=1.46；95%CI=1.23 至 1.75）；母亲妊娠问题（aOR=1.40；95%CI=1.03 至 1.90）；延长（aOR=1.42；95%CI=1.01 至 2.01）或未记录（aOR=1.38；95%CI=1.05 至 1.81）的第二产程时间；阿片类药物使用（aOR=1.31；95%CI=1.02 至 1.68）；肩难产（aOR=5.06；95%CI=3.00 至 8.52）；出生体重<2500g（aOR=4.12；95%CI=1.97 至 8.60）、4000-4999g（aOR=1.64；95%CI=1.25 至 2.14）和≥4500g（aOR=2.10；95%CI=1.17 至 3.76）与新生儿入院或死亡独立相关。在入院的婴儿（n=1038）中，18%接受了重症监护。有 9 名婴儿死亡，其中 6 名在新生儿病房入院后死亡。败血症（52%）和呼吸窘迫（42%）是最常见的出院诊断。
本研究结果与其他关于新生儿入院风险因素的证据一致，并对 AMU 中的护理质量和安全性提供了令人安心的结果。
