University of Alabama at Birmingham School of Medicine, Birmingham.
Department of Pediatrics, University of Alabama at Birmingham, Birmingham.
JAMA Netw Open. 2023 Jan 3;6(1):e2250593. doi: 10.1001/jamanetworkopen.2022.50593.
Active postnatal care has been associated with center differences in survival among periviable infants. Regional differences in outcomes among periviable infants in the US may be associated with differences in active postnatal care.
To determine if regions with higher rates of active postnatal care will have higher gestational age-specific survival rates among periviable infants.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included live births from 22 to 25 weeks' gestation weighing 400 to 999 g in the US Centers for Disease Control and Prevention (CDC) WONDER 2017 to 2020 (expanded) database. Infants with congenital anomalies were excluded. Active postnatal care was defined using the CDC definition of abnormal conditions of newborn as presence of any of the following: neonatal intensive care unit (NICU) admission, surfactant, assisted ventilation, antibiotics, and seizures. Data were analyzed from August to November 2022.
Regional gestational age-specific survival rates were compared with rates of active postnatal care in the 10 US Health and Human Services regions using Kendall τ test.
We included 41 707 periviable infants, of whom 32 674 (78%) were singletons and 19 467 (46.7%) were female. Among those studied 34 983 (83.9%) had evidence of active care, and 26 009 (62.6%) survived. Regional rates of active postnatal care were positively correlated with regional survival rates at 22 weeks' gestation (rτ[8] = 0.56; r2 = 0.31; P = .03) but the correlation was not significant at 23 weeks' gestation (rτ[8] = 0.47; r2 = 0.22; P = .07). There was no correlation between active care and survival at 24 or 25 weeks' gestation. Regional rates of both NICU admission and assisted ventilation following delivery were positively correlated with regional rates of survival at 22 weeks' gestation (both P < .05). Regional rates of antenatal corticosteroids exposure were also positively correlated with regional rates of survival at 22 weeks' gestation (rτ[8] = 0.60; r2 = 0.36; P = .02).
In this cohort study of 41 707 periviable infants, regional differences in rates of active postnatal care, neonatal intensive care unit admission, provision of assisted ventilation and antenatal corticosteroid exposure were moderately correlated with survival at 22 weeks' gestation. Further studies focused on individual-level factors associated with active periviable care are warranted.
积极的产后护理与围产儿生存的中心差异有关。美国围产儿结局的区域差异可能与积极的产后护理差异有关。
确定积极的产后护理率较高的地区，围产儿的特定胎龄生存率是否更高。
设计、地点和参与者：这项队列研究纳入了美国疾病控制与预防中心（CDC）WONDER 2017 至 2020 年（扩展）数据库中胎龄 22 至 25 周、体重 400 至 999 克的活产儿。排除了有先天畸形的婴儿。积极的产后护理使用 CDC 对新生儿异常情况的定义来定义，即存在以下任何一种情况：新生儿重症监护病房（NICU）入院、表面活性剂、辅助通气、抗生素和癫痫发作。数据分析于 2022 年 8 月至 11 月进行。
使用 Kendall τ 检验比较了美国 10 个卫生和人类服务地区的特定胎龄区域生存率与积极的产后护理率。
我们纳入了 41707 名围产儿，其中 32674 名（78%）为单胎，19467 名（46.7%）为女性。在研究的婴儿中，34983 名（83.9%）有积极护理的证据，26009 名（62.6%）存活。区域积极产后护理率与 22 周胎龄的区域生存率呈正相关（rτ[8] = 0.56；r2 = 0.31；P = 0.03），但在 23 周胎龄时相关性不显著（rτ[8] = 0.47；r2 = 0.22；P = 0.07）。24 或 25 周胎龄时，积极护理与生存率之间无相关性。分娩后 NICU 入院和辅助通气的区域率与 22 周胎龄的区域生存率呈正相关（均 P < 0.05）。产前皮质类固醇暴露的区域率也与 22 周胎龄的区域生存率呈正相关（rτ[8] = 0.60；r2 = 0.36；P = 0.02）。
在这项对 41707 名围产儿的队列研究中，积极的产后护理、新生儿重症监护病房入院、辅助通气提供和产前皮质类固醇暴露的区域率差异与 22 周胎龄的生存率呈中度相关。需要进一步研究与积极围产儿护理相关的个体因素。
