Yeast J D, Poskin M, Stockbauer J W, Shaffer S
Perinatal Center, Saint Luke's Hospital of Kansas City, Kansas City, MO 64111, USA.
Am J Obstet Gynecol. 1998 Jan;178(1 Pt 1):131-5. doi: 10.1016/s0002-9378(98)70639-8.
Our goal was to study changing patterns of low-birth-weight outcome over the past decade as deregionalized perinatal care has occurred.
Live births and neonatal mortality for two 5-year periods (1982 to 1986 vs 1990 to 1994) were calculated by hospital of delivery in the state of Missouri. Self-designated level of perinatal care was contrasted with number of deliveries and nursery census to evaluate outcome. Regression models were constructed to compare outcome between levels of care.
There has been a significant shift of deliveries into self-designated level II and III perinatal centers. However, this is largely a result of redesignation of care rather than an actual increase in acuity or census. The relative risk of neonatal mortality for very-low-birth-weight infants is 2.28 in level II centers compared with level III centers, and is unchanged (2.57) from 10 years earlier. Nearly 14% of very-low-birth-weight deliveries still occur at non-level III centers.
Changing patterns of perinatal regionalization have not improved outcome for inborn infants < 1500 gm except in level III centers. Attempts should be made to deliver very-low-birth-weight infants in level III centers.
我们的目标是研究在过去十年围产期护理去区域化过程中低出生体重结局的变化模式。
通过密苏里州的分娩医院计算两个5年期（1982年至1986年与1990年至1994年）的活产数和新生儿死亡率。将自我指定的围产期护理水平与分娩数量和新生儿重症监护病房普查数量进行对比以评估结局。构建回归模型以比较不同护理水平之间的结局。
分娩显著转向自我指定的二级和三级围产期中心。然而，这在很大程度上是护理重新指定的结果，而非实际病情严重程度或普查数量的增加。与三级中心相比，二级中心极低出生体重婴儿的新生儿死亡相对风险为2.28，与10年前相比未变（2.57）。近14%的极低出生体重儿分娩仍发生在非三级中心。
围产期区域化模式的改变并未改善出生体重<1500克的新生儿结局，三级中心除外。应尝试在三级中心分娩极低出生体重儿。
