Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
Arch Dis Child Fetal Neonatal Ed. 2023 Sep;108(5):540-544. doi: 10.1136/archdischild-2022-325157. Epub 2023 Mar 23.
To quantify admissions to neonatal units in England and Wales with potential need for palliative care.
DESIGN, SETTING AND PATIENTS: Diagnoses and clinical attributes indicating a high likelihood of requiring palliative care were mapped to categories within the British Association of Perinatal Medicine's (BAPM) framework on palliative care. We extracted data from the National Neonatal Research Database on all babies born and admitted to neonatal units in England and Wales 2015-2020.
The number and proportion of babies meeting BAPM categories, their discharge outcomes and the characteristics of babies who died during neonatal care but did not fulfil any BAPM category.
12 123/574 954 (2.1%) babies met one or more BAPM category: 6239/12 123 (51%) conformed to BAPM category 4 (postnatal conditions with high risk of severe impairment), 3796 (31%) to category 2 (antenatal/postnatal diagnosis with high risk of significant morbidity or death), 1399 (12%) to category 3 (born at margin of viability) and 288 (2%) to category 1 (antenatal/postnatal diagnosis not compatible with long-term survival); 401 babies (3%) met criteria for multiple categories. 6814/12 123 (56%) were discharged home, 2385 (20%) were discharged to other settings and 2914 (24%) died before neonatal discharge. 3000/5914 (51%) babies who died during neonatal care did not conform to any BAPM category. Of these, 2630/3000 (88%) were born preterm.
At least 2% of babies admitted to neonatal units had palliative care needs according to existing BAPM categories; most survived to discharge. Of deaths, 51% were not captured by the BAPM categories; most were extremely preterm.
量化英格兰和威尔士新生儿病房中可能需要姑息治疗的入院人数。
设计、设置和患者：将具有高可能性需要姑息治疗的诊断和临床特征映射到英国围产医学协会（BAPM）姑息治疗框架内的类别。我们从英格兰和威尔士 2015-2020 年所有新生儿病房出生和入院的新生儿研究数据库中提取数据。
符合 BAPM 类别的婴儿数量和比例、他们的出院结局以及在新生儿护理期间死亡但不符合任何 BAPM 类别的婴儿的特征。
12123/574954（2.1%）名婴儿符合一个或多个 BAPM 类别：6239/12123（51%）符合 BAPM 类别 4（出生后有严重损伤高风险的情况），3796（31%）符合类别 2（产前/产后有严重发病率或死亡高风险的诊断），1399（12%）符合类别 3（出生时接近可行生存边缘），288（2%）符合类别 1（产前/产后诊断不适合长期生存）；401 名婴儿（3%）符合多个类别的标准。12123 名婴儿中有 6814 名（56%）出院回家，2385 名（20%）出院到其他地方，2914 名（24%）在新生儿出院前死亡。3000/5914（51%）在新生儿护理期间死亡的婴儿不符合任何 BAPM 类别。其中，2630/3000（88%）为早产儿。
根据现有的 BAPM 类别，至少有 2%的新生儿病房入院婴儿有姑息治疗需求；大多数存活至出院。在死亡病例中，51%未被 BAPM 类别捕获；大多数是极早产儿。
