Neonatal Medicine, Chelsea and Westminster Hospital Campus, Imperial College London, London, UK.
Department of Medicine, Hull York Medical School, Hull, UK.
BMJ Paediatr Open. 2023 Jul;7(1). doi: 10.1136/bmjpo-2023-002007.
Neonatal care is commonly regionalised, meaning specialist services are only available at certain units. Consequently, infants with surgical conditions needing specialist care who are born in non-surgical centres require postnatal transfer. Best practice models advocate for colocated maternity and surgical services as the place of birth for infants with antenatally diagnosed congenital conditions to avoid postnatal transfers. We conducted a systematic review to explore the association between location of birth and short-term outcomes of babies with gastroschisis, congenital diaphragmatic hernia (CDH) and oesophageal atresia with or without tracheo-oesophageal fistula (TOF/OA).
We searched MEDLINE, CINAHL, Web of Science and SCOPUS databases for studies from high income countries comparing outcomes for infants with gastroschisis, CDH or TOF/OA based on their place of delivery. Outcomes of interest included mortality, length of stay, age at first feed, comorbidities and duration of parenteral nutrition. We assessed study quality using the Newcastle-Ottawa Scale. We present a narrative synthesis of our findings.
Nineteen cohort studies compared outcomes of babies with one of gastroschisis, CDH or TOF/OA. Heterogeneity across the studies precluded meta-analysis. Eight studies carried out case-mix adjustments. Overall, we found conflicting evidence. There is limited evidence to suggest that birth in a maternity unit with a colocated surgical centre was associated with a reduction in mortality for CDH and decreased length of stay for gastroschisis.
There is little evidence to suggest that delivery in colocated maternity-surgical services may be associated with shortened length of stay and reduced mortality. Our findings are limited by significant heterogeneity, potential for bias and paucity of strong evidence. This supports the need for further research to investigate the impact of birth location on outcomes for babies with congenital surgical conditions and inform future design of neonatal care systems.
CRD42022329090.
新生儿护理通常是区域化的，这意味着专科服务只能在某些单位获得。因此，在非手术中心出生但患有外科疾病需要专科护理的婴儿需要进行产后转移。最佳实践模式提倡将妇产科和外科服务设置在同一地点，作为产前诊断为先天性疾病的婴儿的出生地点，以避免产后转移。我们进行了一项系统评价，以探讨婴儿先天性腹壁裂、先天性膈疝（CDH）和食管闭锁伴或不伴气管食管瘘（TOF/OA）的出生地点与短期结局之间的关系。
我们检索了 MEDLINE、CINAHL、Web of Science 和 SCOPUS 数据库，以查找比较基于分娩地点的婴儿先天性腹壁裂、CDH 或 TOF/OA 结局的高收入国家的研究。感兴趣的结局包括死亡率、住院时间、首次喂养年龄、合并症和肠外营养持续时间。我们使用纽卡斯尔-渥太华量表评估研究质量。我们对研究结果进行了叙述性综合。
19 项队列研究比较了先天性腹壁裂、CDH 或 TOF/OA 婴儿的结局。研究之间存在异质性，因此无法进行荟萃分析。8 项研究进行了病例组合调整。总体而言，我们发现证据相互矛盾。有有限的证据表明，在设有外科中心的妇产科分娩与 CDH 死亡率降低和先天性腹壁裂住院时间缩短有关。
几乎没有证据表明在设有妇产科-外科的单位分娩可能与缩短住院时间和降低死亡率有关。我们的研究结果受到显著异质性、潜在偏倚和证据不足的限制。这支持进一步研究的需要，以调查出生地点对先天性外科疾病婴儿结局的影响，并为未来新生儿护理系统的设计提供信息。
PROSPERO 注册号：CRD42022329090。
