Branger B, Chaperon J, Mouzard A, Picherot G, Kerbaol M
Centre Hospitalier, Saint-Nazaire.
Rev Epidemiol Sante Publique. 1994;42(4):307-14.
The rate of neonatal referral from the site of birth to a special care centre is generally related to the conditions of the pregnancy and the status of the neonate. The purpose of this study was to investigate other factors affecting referral including obstetric procedures, and equipment and personnel environment. A prospective survey of the neonatal population in 9 maternity hospital in the Loire-Atlantique area in France was conducted. There were, 1.316 births and the referral rate was 10.3% with a range of 1 to 24% depending on the originating hospital. After adjustment for gestational age, multivariate analysis revealed that the medical variables were the main factors affecting referral rate (positive gastric smear, adjusted odds ratio, ORa = 62.6; disease, ORa = 37.7; Apgar score 1 min < 7, ORa = 9.4; monitoring abnormality, ORa = 3.2; coloured amniotic fluid, CORa = 2.7; birthweight, ORa = 0.3). A high risk of referral was observed in only one maternity hospital (ORa = 9.4) related to a poor environment index. This center was in close vicinity to another maternity hospital. In a regional referral programme, high risk neonates should be delivered in maternity hospitals near a special care centre. But, in order to keep the rate of referral, with its adverse effect on the mother-baby relation, low, care for neonates with minor disease or only slightly underweight at birth should be cared for in these centers without referral.
从出生地点转诊至特殊护理中心的新生儿比例通常与孕期状况及新生儿状态有关。本研究的目的是调查其他影响转诊的因素，包括产科程序、设备及人员环境。对法国大西洋卢瓦尔省9家妇产医院的新生儿群体进行了一项前瞻性调查。共有1316例分娩，转诊率为10.3%，根据转诊起始医院的不同，转诊率在1%至24%之间。在对胎龄进行校正后，多变量分析显示，医学变量是影响转诊率的主要因素（胃液涂片阳性，校正比值比，ORa = 62.6；疾病，ORa = 37.7；1分钟阿氏评分<7，ORa = 9.4；监测异常，ORa = 3.2；羊水有颜色，CORa = 2.7；出生体重，ORa = 0.3）。仅在一家妇产医院观察到较高的转诊风险（ORa = 9.4），这与环境指数较差有关。该中心与另一家妇产医院距离很近。在区域转诊计划中，高危新生儿应在靠近特殊护理中心的妇产医院分娩。但是，为了使转诊率及其对母婴关系的不利影响保持在较低水平，对于患有轻微疾病或出生时仅略低于正常体重的新生儿，应在这些中心进行护理而无需转诊。
