台湾极低出生体重儿的新生儿和婴儿死亡率：分娩医院的级别是否重要？

Neonatal and infant mortality of very-low-birth-weight infants in Taiwan: Does the level of delivery hospital matter?

机构信息

Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

出版信息

Pediatr Neonatol. 2021 Jul;62(4):419-427. doi: 10.1016/j.pedneo.2021.04.003. Epub 2021 Apr 27.

DOI:10.1016/j.pedneo.2021.04.003

PMID:34020899

Abstract

BACKGROUND

To study the distribution of the birthplaces of very-low-birth-weight (VLBW) infants and examine whether delivery at different levels of hospital affects neonatal and infant mortality.

METHODS

This population-based cohort study was retrieved from Taiwan Maternal and Child Health Database. Livebirth singleton VLBW infants born between 2011 and 2014, with BW between 500 and 1499 g and gestational age ≥22 weeks were enrolled. The main outcomes were risk-adjusted odds ratios (aOR) of neonatal and infant mortality by birthplace, which was categorized as medical center (MC), regional hospital (RH), district hospital (DH), and clinic (C) based on Taiwan's hospital accreditation system.

RESULTS

Of 4560 VLBW infants enrolled, 3005 (66%) were born in MCs, 1181 (26%) in RHs, 213 (5%) in DHs, and 161 (4%) in Cs. Neonatal mortality rates were 10%, 15%, 16%, 17%, and infant mortality rates were 13%, 17%, 18%, 21%, if born in MCs, RHs, DHs and Cs, respectively. The aORs for neonatal and infant mortality were 1.94 (95% CI 1.53-2.48) and 1.67 (1.34-2.08) for those born in RHs, 2.26 (1.38-3.70) and 1.82 (1.16-2.86) for infants born in DHs/Cs, as compared to those born in MCs. For VLBW infants born in RHs, DHs, and Cs and postnatally transferred to MCs, the aORs of neonatal and infant mortality were lower than those who were not transferred.

CONCLUSION

VLBW infants born outside of MCs had higher neonatal and infant mortality and a two-fold higher risk of mortality than those born in MCs. When possible, VLBW infants should be born in MCs.

摘要

背景

研究极低出生体重儿（VLBW）的出生地分布，并探讨不同级别的医院分娩对新生儿和婴儿死亡率的影响。

方法

本基于人群的队列研究数据来自台湾母婴健康数据库。纳入 2011 年至 2014 年间出生、出生体重 500 至 1499 克、胎龄≥22 周的活产单胎 VLBW 婴儿。主要结局为根据台湾医院认证系统将出生地分为医疗中心（MC）、区域医院（RH）、地区医院（DH）和诊所（C）后，新生儿和婴儿死亡率的风险调整比值比（aOR）。

结果

在纳入的 4560 名 VLBW 婴儿中，3005 名（66%）出生于 MC，1181 名（26%）出生于 RH，213 名（5%）出生于 DH，161 名（4%）出生于 C。如果出生于 MC、RH、DH 和 C，新生儿死亡率分别为 10%、15%、16%、17%，婴儿死亡率分别为 13%、17%、18%、21%。与出生于 MC 的婴儿相比，出生于 RH 的新生儿和婴儿死亡率的 aOR 分别为 1.94（95%CI 1.53-2.48）和 1.67（1.34-2.08），出生于 DH/C 的新生儿和婴儿死亡率的 aOR 分别为 2.26（1.38-3.70）和 1.82（1.16-2.86）。对于出生于 RH、DH 和 C 并在出生后转至 MC 的 VLBW 婴儿，新生儿和婴儿死亡率的 aOR 低于未转院的婴儿。