Craig Alexa, Cutler Anya, Kerecman Jay, Melendi Misty, Seften Leah Marie, Ryzewski Matthew, Zanno Allison, Barkhuff Whittney, O'Reilly Deirdre
Barbara Bush Children's Hospital at Maine Medical Center.
MaineHealth Institute for Research.
Res Sq. 2024 Dec 18:rs.3.rs-5404622. doi: 10.21203/rs.3.rs-5404622/v1.
We hypothesized that outborn neonates from smaller birth volume hospitals would have more frequent adverse short-term outcomes following therapeutic hypothermia (TH).
Multicenter retrospective study comparing outcomes for small (<500 births/year), medium (501-1500 births/year), and large (>1500 births/year) hospitals in Northern New England. Multivariable logistic regression assessed the combined outcome of death/severe gray matter injury on MRI, controlling for encephalopathy severity and time to initiation of TH.
531 neonates were included from small (N=120), medium (N=193), and large (N=218) volume hospitals and TH was initiated at a median of 4.5, 4, and 2 hours of life respectively. The odds of the combined outcome were 4.3-fold higher in small versus large birth volume hospitals (95% CI = 1.6, 12.1, p=0.004), but not different in medium birth volume hospitals.
Neonates born in small volume hospitals had significantly higher odds of death or severe gray matter injury following TH.
我们推测，来自出生量较小医院的院外新生儿在进行亚低温治疗（TH）后出现不良短期结局的频率会更高。
一项多中心回顾性研究，比较新英格兰北部小型（<500例/年）、中型（501 - 1500例/年）和大型（>1500例/年）医院的治疗结果。多变量逻辑回归分析评估了MRI上死亡/严重灰质损伤的综合结局，并对脑病严重程度和开始TH的时间进行了控制。
共纳入来自小型（N = 120）、中型（N = 193）和大型（N = 218）医院的531例新生儿，开始TH的中位时间分别为出生后4.5小时、4小时和2小时。小型医院与大型医院相比，综合结局的比值比高4.3倍（95%可信区间 = 1.6, 12.1, p = 0.004），但中型医院无差异。
在小型医院出生的新生儿在接受TH后死亡或发生严重灰质损伤的几率显著更高。
