Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
J Perinatol. 2024 Oct;44(10):1409-1415. doi: 10.1038/s41372-024-01901-x. Epub 2024 Feb 27.
Evaluate the relationship of neonatal unit level of care (LOC) and volume with mortality or morbidity in moderate-late preterm (MLP) (32-36 weeks' gestation) infants.
Retrospective cohort study of 650,865 inborn MLP infants in 4976 hospitals-years using 2003-2015 linked administrative data from 4 states. Exposure was combined neonatal LOC and MLP annual volume. The primary outcome was death or morbidity (respiratory distress syndrome, severe intraventricular hemorrhage, necrotizing enterocolitis, sepsis, infection, pneumothorax, extreme length of stay) with components as secondary outcomes. Poisson regression models adjusted for patient characteristics with a random effect for unit were used.
In adjusted models, high-volume level 2 units had a lower risk of the primary outcome compared to low-volume level 3 units (aIRR 0.90 [95% CI 0.83-0.98] vs. aIRR 1.13 [95% CI 1.03-1.24], p < 0.001) CONCLUSION: MLP infants had improved outcomes in high-volume level 2 units compared to low-volume level 3 units in adjusted analysis.
评估新生儿病房护理水平（LOC）和数量与中度晚期早产儿（MLP）（32-36 周妊娠）死亡率或发病率的关系。
对来自 4 个州的 2003-2015 年 4976 家医院年的 650865 例宫内 MLP 婴儿进行回顾性队列研究，采用 2003-2015 年的 4 个州的行政数据进行链接。暴露因素为新生儿 LOC 和 MLP 年数量的组合。主要结局为死亡或发病率（呼吸窘迫综合征、严重脑室出血、坏死性小肠结肠炎、败血症、感染、气胸、极端住院时间），各组成部分为次要结局。采用泊松回归模型，根据患者特征进行调整，并对单位进行随机效应调整。
在调整后的模型中，与低容量 3 级单位相比，高容量 2 级单位发生主要结局的风险较低（调整后相对风险率 [aIRR] 0.90 [95%置信区间 [CI] 0.83-0.98] vs. aIRR 1.13 [95% CI 1.03-1.24]，p < 0.001）。
在调整分析中，与低容量 3 级单位相比，高容量 2 级单位的 MLP 婴儿的结局更好。
