Obladen M, Luttkus A, Rey M, Metze B, Hopfenmüller W, Dudenhausen J W
Department of Neonatology, University Clinics Rudolf Virchow, Free University of Berlin, Fed. Rep. of Germany.
J Perinat Med. 1994;22(1):53-64. doi: 10.1515/jpme.1994.22.1.53.
Maternal and social risk, prenatal and obstetric care, resuscitation and neonatal care in very-low-birthweight infants (VLBW) may vary with the type of referral. In 453 VLBW's (< 1500 g) admitted to our neonatal intensive care unit 1987-1992, we classified transport type as: A: No transport (n = 240), B: Maternal transport (n = 88), C: Infant transport (n = 125). Stepwise multiple discriminant function was determined for the identified factors. The risk of mortality was investigated by logistic regression analysis. In group A, mean maternal age was higher and mothers' social status lower than in groups B and C. In group B, infants were considerably smaller and less mature, but when adjusted for gestational age, suffered less frequently from RDS, obviously due to more frequent induction of lung maturation. In group C, less than half of the infants were resuscitated by a neonatologist. Infants of this group were frequently hypothermic at admission and required prolonged artificial ventilation more frequently. Total VLBW survival averaged 77%, increasing from 69 to 88% within the study period. Total rate of severe intraventricular hemorrhage was 4.8% in surviving infants. VLBW infants with different forms of referral differ in their inherent risk. After maternal transport they have less morbidity despite a higher grade of immaturity. Regionalization of perinatal care for these infants remains the greatest potential for further reduction in infant mortality.
极低出生体重儿（VLBW）的母体和社会风险、产前及产科护理、复苏及新生儿护理可能因转诊类型而异。在1987年至1992年入住我们新生儿重症监护病房的453例极低出生体重儿（<1500克）中，我们将转运类型分为：A：无转运（n = 240），B：母体转运（n = 88），C：婴儿转运（n = 125）。对已确定的因素确定逐步多元判别函数。通过逻辑回归分析研究死亡风险。在A组中，母亲的平均年龄较高，母亲的社会地位低于B组和C组。在B组中，婴儿明显更小且更不成熟，但在根据胎龄调整后，患呼吸窘迫综合征（RDS）的频率较低，显然是由于更频繁地诱导肺成熟。在C组中，不到一半的婴儿由新生儿科医生进行复苏。该组婴儿入院时经常体温过低，需要更频繁地进行长时间人工通气。极低出生体重儿的总体存活率平均为77%，在研究期间从69%增至88%。存活婴儿的严重脑室内出血总发生率为4.8%。不同转诊形式的极低出生体重儿固有风险不同。经母体转运后，尽管不成熟程度较高，但发病率较低。对这些婴儿进行围产期护理区域化仍然是进一步降低婴儿死亡率的最大潜力所在。
