农村地区低医院分娩量与接受治疗性低温治疗的新生儿短期不良结局的关联。
Association of low hospital birth volume and adverse short-term outcomes for neonates treated with therapeutic hypothermia in rural states.
作者信息
Craig Alexa K, Cutler Anya, Kerecman Jay, Melendi Misty, Seften Leah Marie, Ryzewski Matthew, Zanno Allison, O'Reilly Deirdre
机构信息
Division of Pediatric Neurology, Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, USA.
Associate Professor of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.
出版信息
J Perinatol. 2025 Jul 6. doi: 10.1038/s41372-025-02352-8.
OBJECTIVE
We hypothesized that outborn neonates in three rural states would have more frequent adverse short-term outcomes following therapeutic hypothermia (TH).
STUDY DESIGN
Multicenter retrospective study comparing outcomes for low (<500 births/year), medium (501-1500 births/year), and high (>1500 births/year) birth volume 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.
RESULTS
Death occurred for 35/531 neonates: 15/120 (12%) low, 7/193 (4%) medium, and 13/218 (6%) for high birth volume hospitals (p = 0.008). Severe gray matter injury occurred in 8%, 6% and 7% of low, medium, and high birth volume hospitals, respectively (p = 0.7). Odds of the combined outcome were 4.3-fold higher in low versus high volume hospitals (95% CI = 1.6, 12.1, p = 0.004).
CONCLUSION
Neonates born in low volume birth hospitals had significantly higher odds of death following treatment with TH.
目的
我们假设三个农村州的外出生新生儿在接受亚低温治疗（TH）后会有更频繁的不良短期结局。
研究设计
多中心回顾性研究，比较新英格兰北部低（<500例/年）、中（501 - 1500例/年）、高（>1500例/年）出生量医院的结局。多变量逻辑回归评估MRI上死亡/严重灰质损伤的综合结局，控制脑病严重程度和开始TH的时间。
结果
531例新生儿中有35例死亡：低出生量医院15/120例（12%），中出生量医院7/193例（4%），高出生量医院13/218例（6%）（p = 0.008）。低、中、高出生量医院分别有8%、6%和7%发生严重灰质损伤（p = 0.7）。低出生量医院与高出生量医院相比，综合结局的比值比高4.3倍（95%CI = 1.6, 12.1, p = 0.004）。
结论
在低出生量医院出生的新生儿接受TH治疗后死亡几率显著更高。
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