Menard M K, Liu Q, Holgren E A, Sappenfield W M
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston 29425-2233, USA.
Am J Obstet Gynecol. 1998 Aug;179(2):374-81. doi: 10.1016/s0002-9378(98)70367-9.
The purpose of this study was to determine whether neonatal mortality rates for very low birth weight (500 to 1499 g) infants born in South Carolina differ by level of perinatal services available at the hospital of birth.
Linked live birth certificates and infant death certificates for 1993 through 1995 were used. Birth weight-specific neonatal mortality rates among 2375 very low birth weight infants were estimated and analyzed by race and by level of perinatal services at the hospital of birth. Rates were compared with chi2 analysis.
Seventy-eight percent of very low birth weight deliveries occurred in level III hospitals. The overall neonatal mortality rate was 178 deaths/1000 very low birth weight live births. Neonatal mortality rates, adjusted for birth weight and race, were significantly higher (P < .05) for infants born in level I hospitals (267 deaths/1000 live births), all level II hospitals (232 deaths/1000 live births), and level II hospitals with neonatologists (213 deaths/1000 live births) than for infants born in level III centers (146 deaths/1000 live births).
Very low birth weight infants are more likely to survive if born in level III hospitals than in level I or II facilities, with or without neonatologists. Obstetric providers should support public health efforts and perinatal health systems to ensure that all women have access to a strong system of risk-appropriate perinatal care.
本研究旨在确定南卡罗来纳州出生的极低出生体重（500至1499克）婴儿的新生儿死亡率是否因出生医院提供的围产期服务水平而异。
使用了1993年至1995年的关联出生证明和婴儿死亡证明。对2375名极低出生体重婴儿按种族和出生医院的围产期服务水平估计并分析了出生体重特异性新生儿死亡率。采用卡方分析比较死亡率。
78%的极低出生体重儿在三级医院分娩。总体新生儿死亡率为每1000例极低出生体重活产中有178例死亡。经出生体重和种族调整后，一级医院（每1000例活产中有267例死亡）、所有二级医院（每1000例活产中有232例死亡）以及有新生儿科医生的二级医院（每1000例活产中有213例死亡）出生的婴儿的新生儿死亡率显著高于三级中心出生的婴儿（每1000例活产中有146例死亡）（P < 0.05）。
极低出生体重婴儿在三级医院出生比在一级或二级医疗机构出生更有可能存活，无论这些机构有无新生儿科医生。产科医疗服务提供者应支持公共卫生工作和围产期卫生系统，以确保所有妇女都能获得强大的、与风险相适应的围产期护理系统。
