2003 年至 2012 年极早产儿分娩和新生儿结局管理政策的变化：十个欧洲地区的两项基于人群的研究。

Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012: two population-based studies in ten European regions.

机构信息

Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.

Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

出版信息

BJOG. 2017 Sep;124(10):1595-1604. doi: 10.1111/1471-0528.14639. Epub 2017 May 5.

DOI:10.1111/1471-0528.14639

PMID:28294506

Abstract

OBJECTIVE

To investigate changes in maternity and neonatal unit policies towards extremely preterm infants (EPTIs) between 2003 and 2012, and concurrent trends in their mortality and morbidity in ten European regions.

DESIGN

Population-based cohort studies in 2003 (MOSAIC study) and 2011/2012 (EPICE study) and questionnaires from hospitals.

SETTING

70 hospitals in ten European regions.

POPULATION

Infants born at <27 weeks of gestational age (GA) in hospitals participating in both the MOSAIC and EPICE studies (1240 in 2003, 1293 in 2011/2012).

METHODS

We used McNemar's Chi test, paired t-tests and conditional logistic regression for comparisons over time.

MAIN OUTCOMES MEASURES

Reported policies, mortality and morbidity of EPTIs.

RESULTS

The lowest GA at which maternity units reported performing a caesarean section for acute distress of a singleton non-malformed fetus decreased from an average of 24.7 to 24.1 weeks (P < 0.01) when parents were in favour of active management, and 26.1 to 25.2 weeks (P = 0.01) when parents were against. Units reported that neonatologists were called more often for spontaneous deliveries starting at 22 weeks GA in 2012 and more often made decisions about active resuscitation alone, rather than in multidisciplinary teams. In-hospital mortality after live birth for EPTIs decreased from 50% to 42% (P < 0.01). Units reporting more active management in 2012 than 2003 had higher mortality in 2003 (55% versus 43%; P < 0.01) and experienced larger declines (55 to 44%; P < 0.001) than units where policies stayed the same (43 to 37%; P = 0.1).

CONCLUSIONS

European hospitals reporting changes in management policies experienced larger survival gains for EPTIs.

TWEETABLE ABSTRACT

Changes in reported policies for management of extremely preterm births were related to mortality declines.

摘要

目的

调查 2003 年至 2012 年期间，产科和新生儿病房对极早产儿（EPTI）政策的变化，以及这十年间欧洲十个地区 EPTI 的死亡率和发病率的变化趋势。

设计

2003 年（MOSAIC 研究）和 2011/2012 年（EPICE 研究）的基于人群的队列研究以及医院的问卷调查。

地点

欧洲十个地区的 70 家医院。

人群

在参与 MOSAIC 和 EPICE 研究的医院出生、胎龄 <27 周的婴儿（2003 年 1240 例，2011/2012 年 1293 例）。

方法

我们使用 McNemar's Chi 检验、配对 t 检验和条件逻辑回归进行时间比较。

主要观察指标

EPTI 的报告政策、死亡率和发病率。

结果

当父母赞成积极管理时，产科报告行剖宫产术以治疗单胎非畸形胎儿急性窘迫的最低胎龄从平均 24.7 周降至 24.1 周（P < 0.01）；当父母反对时，从 26.1 周降至 25.2 周（P = 0.01）。报告显示，在 2012 年，新生儿科医生开始更频繁地在 22 周 GA 时被召唤参与自然分娩，并且更倾向于单独进行积极复苏决策，而不是在多学科团队中进行决策。EPTI 活产后的院内死亡率从 50%降至 42%（P < 0.01）。与 2003 年相比，2012 年报告管理更积极的单位，2003 年死亡率更高（55%对 43%；P < 0.01），且降幅更大（55 降至 44%；P < 0.001），而政策保持不变的单位降幅较小（43 降至 37%；P = 0.1）。