PDF(Pubmed)
Abstract：
Neonatal care is commonly regionalised, meaning specialist services are only available at certain units. Consequently, infants with surgical conditions needing specialist care who are born in non-surgical centres require postnatal transfer. Best practice models advocate for colocated maternity and surgical services as the place of birth for infants with antenatally diagnosed congenital conditions to avoid postnatal transfers. We conducted a systematic review to explore the association between location of birth and short-term outcomes of babies with gastroschisis, congenital diaphragmatic hernia (CDH) and oesophageal atresia with or without tracheo-oesophageal fistula (TOF/OA).
We searched MEDLINE, CINAHL, Web of Science and SCOPUS databases for studies from high income countries comparing outcomes for infants with gastroschisis, CDH or TOF/OA based on their place of delivery. Outcomes of interest included mortality, length of stay, age at first feed, comorbidities and duration of parenteral nutrition. We assessed study quality using the Newcastle-Ottawa Scale. We present a narrative synthesis of our findings.
Nineteen cohort studies compared outcomes of babies with one of gastroschisis, CDH or TOF/OA. Heterogeneity across the studies precluded meta-analysis. Eight studies carried out case-mix adjustments. Overall, we found conflicting evidence. There is limited evidence to suggest that birth in a maternity unit with a colocated surgical centre was associated with a reduction in mortality for CDH and decreased length of stay for gastroschisis.
There is little evidence to suggest that delivery in colocated maternity-surgical services may be associated with shortened length of stay and reduced mortality. Our findings are limited by significant heterogeneity, potential for bias and paucity of strong evidence. This supports the need for further research to investigate the impact of birth location on outcomes for babies with congenital surgical conditions and inform future design of neonatal care systems.
CRD42022329090.
We searched MEDLINE, CINAHL, Web of Science and SCOPUS databases for studies from high income countries comparing outcomes for infants with gastroschisis, CDH or TOF/OA based on their place of delivery. Outcomes of interest included mortality, length of stay, age at first feed, comorbidities and duration of parenteral nutrition. We assessed study quality using the Newcastle-Ottawa Scale. We present a narrative synthesis of our findings.
Nineteen cohort studies compared outcomes of babies with one of gastroschisis, CDH or TOF/OA. Heterogeneity across the studies precluded meta-analysis. Eight studies carried out case-mix adjustments. Overall, we found conflicting evidence. There is limited evidence to suggest that birth in a maternity unit with a colocated surgical centre was associated with a reduction in mortality for CDH and decreased length of stay for gastroschisis.
There is little evidence to suggest that delivery in colocated maternity-surgical services may be associated with shortened length of stay and reduced mortality. Our findings are limited by significant heterogeneity, potential for bias and paucity of strong evidence. This supports the need for further research to investigate the impact of birth location on outcomes for babies with congenital surgical conditions and inform future design of neonatal care systems.
CRD42022329090.
摘要：
背景：新生儿护理通常是区域性的，这意味着专业服务仅在某些单位可用。因此,在非手术中心出生的患有手术疾病需要专科护理的婴儿需要产后转移。最佳实践模式提倡将同位分娩和手术服务作为产前诊断为先天性疾病的婴儿的出生地，以避免产后转移。我们进行了系统评价，以探讨出生位置与腹裂婴儿的短期结局之间的关系。先天性膈疝（CDH）和食管闭锁伴或不伴气管食管瘘（TOF/OA）。
方法：我们搜索了MEDLINE，CINAHL,WebofScience和SCOPUS数据库，用于高收入国家的研究，比较患有胃裂的婴儿的结局，CDH或TOF/OA基于其交付地点。感兴趣的结果包括死亡率，逗留时间,第一次进食的年龄，肠外营养的合并症和持续时间。我们使用纽卡斯尔-渥太华量表评估研究质量。我们提出了我们的研究结果的叙述性综合。
结果：19项队列研究比较了患有腹裂的婴儿的结局，CDH或TOF/OA。研究中的异质性排除了荟萃分析。八项研究进行了病例组合调整。总的来说,我们发现了相互矛盾的证据.有限的证据表明，在同一地点手术中心的产科分娩与CDH死亡率降低和胃裂住院时间缩短有关。
结论：几乎没有证据表明在同一地点的产妇手术服务中分娩可能与缩短住院时间和降低死亡率有关。我们的发现受到显著异质性的限制，潜在的偏见和缺乏强有力的证据。这支持需要进一步研究，以调查出生位置对先天性手术条件婴儿结局的影响，并为未来的新生儿护理系统设计提供信息。
■CRD42022329090。
方法：我们搜索了MEDLINE，CINAHL,WebofScience和SCOPUS数据库，用于高收入国家的研究，比较患有胃裂的婴儿的结局，CDH或TOF/OA基于其交付地点。感兴趣的结果包括死亡率，逗留时间,第一次进食的年龄，肠外营养的合并症和持续时间。我们使用纽卡斯尔-渥太华量表评估研究质量。我们提出了我们的研究结果的叙述性综合。
结果：19项队列研究比较了患有腹裂的婴儿的结局，CDH或TOF/OA。研究中的异质性排除了荟萃分析。八项研究进行了病例组合调整。总的来说,我们发现了相互矛盾的证据.有限的证据表明，在同一地点手术中心的产科分娩与CDH死亡率降低和胃裂住院时间缩短有关。
结论：几乎没有证据表明在同一地点的产妇手术服务中分娩可能与缩短住院时间和降低死亡率有关。我们的发现受到显著异质性的限制，潜在的偏见和缺乏强有力的证据。这支持需要进一步研究，以调查出生位置对先天性手术条件婴儿结局的影响，并为未来的新生儿护理系统设计提供信息。
■CRD42022329090。
