Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
Erasmus School of Economics, Tinbergen Institute and Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, the Netherlands.
JAMA Netw Open. 2023 Dec 1;6(12):e2347444. doi: 10.1001/jamanetworkopen.2023.47444.
Extremely preterm infants require care provided in neonatal intensive care units (NICUs) to survive. In the Netherlands, a decision is made regarding active treatment between 24 weeks 0 days and 25 weeks 6 days after consultation with the parents.
To investigate the association between maternal migration background and admissions to NICUs and mortality within the first year among extremely preterm infants.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study linked data of registered births in the Netherlands with household-level income tax records and municipality and mortality registers. Eligible participants were households with live births at 24 weeks 0 days to 25 weeks 6 days gestation between January 1, 2010, and December 31, 2017. Data linkage and analysis was performed from March 1, 2020, to June 30, 2023.
Maternal migration background, defined as no migration background vs first- or second-generation migrant mother.
Admissions to NICUs and mortality within the first week, month, and year of life. Logistic regressions were estimated adjusted for year of birth, maternal age, parity, household income, sex, gestational age, multiple births, and small for gestational age. NICU-specific fixed effects were also included.
Among 1405 live births (768 male [54.7%], 546 [38.9%] with maternal migration background), 1243 (88.5%) were admitted to the NICU; 490 of 546 infants (89.7%) born to mothers with a migration background vs 753 of 859 infants (87.7%) born to mothers with no migration background were admitted to NICU (fully adjusted RR, 1.03; 95% CI, 0.99-1.08). A total of 652 live-born infants (46.4%) died within the first year of life. In the fully adjusted model, infants born to mothers with a migration background had lower risk of mortality within the first week (RR, 0.81; 95% CI, 0.66-0.99), month (RR, 0.84; 95% CI, 0.72-0.97), and year of life (RR, 0.85; 95% CI, 0.75-0.96) compared with infants born to mothers with no migration background.
In this nationally representative cross-sectional study, infants born to mothers with a migration background at 24 weeks 0 days to 25 weeks 6 days of gestation in the Netherlands had lower risk of mortality within the first year of life than those born to mothers with no migration background, a result that was unlikely to be explained by mothers from different migration backgrounds attending different NICUs or differential preferences for active obstetric management across migration backgrounds. Further research is needed to understand the underlying mechanisms driving these disparities, including parental preferences for active care of extremely preterm infants.
极早产儿需要在新生儿重症监护病房（NICU）接受治疗才能存活。在荷兰，在与父母协商后，会在 24 周零 0 天至 25 周零 6 天之间做出关于积极治疗的决定。
调查极早产儿母亲移民背景与入住新生儿重症监护病房（NICU）和出生后第一年死亡率之间的关系。
设计、地点和参与者：本横断面研究将荷兰注册出生数据与家庭所得税记录以及市和死亡率登记处的数据进行了关联。合格的参与者是在 2010 年 1 月 1 日至 2017 年 12 月 31 日期间，妊娠 24 周零 0 天至 25 周零 6 天之间出生的活产儿家庭。数据链接和分析于 2020 年 3 月 1 日至 2023 年 6 月 30 日进行。
母亲的移民背景，定义为无移民背景与第一代或第二代移民母亲。
出生后第一周、第一个月和第一年入住新生儿重症监护病房（NICU）和死亡率。使用出生年份、母亲年龄、产次、家庭收入、性别、胎龄、多胎妊娠和小于胎龄等因素进行调整后，采用 logistic 回归进行估计。还包括了 NICU 特定的固定效应。
在 1405 例活产儿（768 例男性[54.7%]，546 例母亲有移民背景[38.9%]）中，有 1243 例（88.5%）被收治入 NICU；546 例母亲有移民背景的婴儿中有 490 例（89.7%）与 859 例母亲无移民背景的婴儿中有 753 例（87.7%）被收治入 NICU（完全调整后的 RR，1.03；95%CI，0.99-1.08）。共有 652 名活产婴儿（46.4%）在出生后第一年死亡。在完全调整的模型中，与无移民背景的母亲所生的婴儿相比，母亲有移民背景的婴儿在出生后第一周（RR，0.81；95%CI，0.66-0.99）、第一个月（RR，0.84；95%CI，0.72-0.97）和第一年（RR，0.85；95%CI，0.75-0.96）的死亡率较低。
在这项具有全国代表性的横断面研究中，与无移民背景的母亲所生的 24 周零 0 天至 25 周零 6 天的极早产儿相比，母亲有移民背景的婴儿在出生后第一年的死亡率较低，这一结果不太可能是由于来自不同移民背景的母亲选择不同的 NICU 或在移民背景方面对积极产科管理的偏好不同所致。需要进一步研究以了解导致这些差异的潜在机制，包括父母对极早产儿积极护理的偏好。
