Bruns Nora, Feddahi Nadia, Hojeij Rayan, Rossi Rainer, Dohna-Schwake Christian, Stein Anja, Kobus Susann, Stang Andreas, Kowall Bernd, Felderhoff-Müser Ursula
Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; C-TNBS, Centre for Translational Neuro- and Behavioural Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, Pediatric Neurology, and Pediatric Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; C-TNBS, Centre for Translational Neuro- and Behavioural Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Resuscitation. 2024 Sep;202:110309. doi: 10.1016/j.resuscitation.2024.110309. Epub 2024 Jul 11.
In neonates with birth asphyxia (BA) and hypoxic-ischemic encephalopathy, therapeutic hypothermia (TH), initiated within six hours, is the only safe and established neuroprotective measure to prevent secondary brain injury. Infants born outside of TH centers have delayed access to cooling.
To compare in-hospital mortality, occurrence of seizures, and functional status at discharge in newborns with BA depending on postnatal transfer for treatment to another hospital within 24 h of admission (transferred (TN) versus non-transferred neonates (NTN)).
Nationwide retrospective cohort study from a comprehensive hospital dataset using codes of the International Classification of Diseases, 10th modification (ICD-10). Clinical and outcome information was retrieved from diagnostic and procedural codes. Hierarchical multilevel logistic regression modeling was performed to quantify the effect of being postnatally transferred on target outcomes.
All discharges from German hospitals from 2016 to 2021.
Full term neonates with birth asphyxia (ICD-10 code: P21) admitted to a pediatric department on their first day of life.
Postnatal transfer to a pediatric department within 24 h of admission to an external hospital.
In-hospital death; secondary outcomes: seizures and pediatric complex chronic conditions category (PCCC) ≥ 2.
Of 11,703,800 pediatric cases, 25,914 fulfilled the inclusion criteria. TNs had higher proportions of organ dysfunction, TH, organ replacement therapies, and neurological sequelae in spite of slightly lower proportions of maternal risk factors. In TNs, the adjusted odds ratios (OR) for death, seizures, and PCCC ≥ 2 were 4.08 ((95% confidence interval 3.41-4.89), 2.99 (2.65-3.38), and 1.76 (1.52-2.05), respectively. A subgroup analysis among infants receiving TH (n = 3,283) found less pronounced adjusted ORs for death (1.67 (1.29-2.17)) and seizures (1.26 (1.07-1.48)) and inverse effects for PCCC ≥ 2 (0.81 (0.64-1.02)) in TNs.
This comprehensive nationwide study found increased odds for adverse outcomes in neonates with BA who were transferred to another facility within 24 h of hospital admission. Closely linking obstetrical units to a pediatric department and balancing geographical coverage of different levels of care facilities might help to minimize risks for postnatal emergency transfer and optimize perinatal care.
在患有出生窒息（BA）和缺氧缺血性脑病的新生儿中，在6小时内开始的治疗性低温（TH）是预防继发性脑损伤的唯一安全且已确立的神经保护措施。在非TH中心出生的婴儿获得降温治疗的时间会延迟。
比较因出生窒息而在入院后24小时内转至另一家医院接受治疗（转院（TN）与未转院新生儿（NTN））的新生儿的院内死亡率、癫痫发作发生率和出院时的功能状态。
使用国际疾病分类第10版（ICD-10）编码，对综合医院数据集进行全国性回顾性队列研究。临床和结局信息从诊断和程序编码中获取。进行分层多级逻辑回归建模以量化出生后转院对目标结局的影响。
2016年至2021年德国医院的所有出院病例。
出生第一天入住儿科的足月出生窒息新生儿（ICD-10编码：P21）。
入院后24小时内转至儿科。
院内死亡；次要结局：癫痫发作和儿科复杂慢性病类别（PCCC）≥2。
在11703800例儿科病例中，25914例符合纳入标准。尽管产妇危险因素比例略低，但转院新生儿的器官功能障碍、TH、器官替代疗法和神经后遗症比例更高。在转院新生儿中，死亡、癫痫发作和PCCC≥2的调整优势比（OR）分别为4.08（（95%置信区间3.41-4.89）、2.99（2.65-3.38）和1.76（1.52-2.05）。在接受TH的婴儿（n = 3283）中的亚组分析发现，转院新生儿中死亡（1.67（1.29-2.17））和癫痫发作（1.26（1.07-1.48））的调整OR不太明显，而PCCC≥2则有相反作用（0.81（0.64-1.02））。
这项全面的全国性研究发现，入院后24小时内转至另一家机构的出生窒息新生儿出现不良结局的几率增加。将产科单位与儿科紧密联系起来，并平衡不同级别护理机构的地理覆盖范围，可能有助于将出生后紧急转院的风险降至最低，并优化围产期护理。
