Abstract：
OBJECTIVE: In neonates with birth asphyxia (BA) and hypoxic-ischemic encephalopathy, therapeutic hypothermia (TH), initiated within six hours, is the only safe and established neuroprotective measure to prevent secondary brain injury. Infants born outside of TH centers have delayed access to cooling.
OBJECTIVE: To compare in-hospital mortality, occurrence of seizures, and functional status at discharge in newborns with BA depending on postnatal transfer for treatment to another hospital within 24 h of admission (transferred (TN) versus non-transferred neonates (NTN)).
METHODS: Nationwide retrospective cohort study from a comprehensive hospital dataset using codes of the International Classification of Diseases, 10th modification (ICD-10). Clinical and outcome information was retrieved from diagnostic and procedural codes. Hierarchical multilevel logistic regression modeling was performed to quantify the effect of being postnatally transferred on target outcomes.
METHODS: All discharges from German hospitals from 2016 to 2021.
METHODS: Full term neonates with birth asphyxia (ICD-10 code: P21) admitted to a pediatric department on their first day of life.
METHODS: Postnatal transfer to a pediatric department within 24 h of admission to an external hospital.
RESULTS: In-hospital death; secondary outcomes: seizures and pediatric complex chronic conditions category (PCCC) ≥ 2.
RESULTS: Of 11,703,800 pediatric cases, 25,914 fulfilled the inclusion criteria. TNs had higher proportions of organ dysfunction, TH, organ replacement therapies, and neurological sequelae in spite of slightly lower proportions of maternal risk factors. In TNs, the adjusted odds ratios (OR) for death, seizures, and PCCC ≥ 2 were 4.08 ((95% confidence interval 3.41-4.89), 2.99 (2.65-3.38), and 1.76 (1.52-2.05), respectively. A subgroup analysis among infants receiving TH (n = 3,283) found less pronounced adjusted ORs for death (1.67 (1.29-2.17)) and seizures (1.26 (1.07-1.48)) and inverse effects for PCCC ≥ 2 (0.81 (0.64-1.02)) in TNs.
CONCLUSIONS: This comprehensive nationwide study found increased odds for adverse outcomes in neonates with BA who were transferred to another facility within 24 h of hospital admission. Closely linking obstetrical units to a pediatric department and balancing geographical coverage of different levels of care facilities might help to minimize risks for postnatal emergency transfer and optimize perinatal care.
OBJECTIVE: To compare in-hospital mortality, occurrence of seizures, and functional status at discharge in newborns with BA depending on postnatal transfer for treatment to another hospital within 24 h of admission (transferred (TN) versus non-transferred neonates (NTN)).
METHODS: Nationwide retrospective cohort study from a comprehensive hospital dataset using codes of the International Classification of Diseases, 10th modification (ICD-10). Clinical and outcome information was retrieved from diagnostic and procedural codes. Hierarchical multilevel logistic regression modeling was performed to quantify the effect of being postnatally transferred on target outcomes.
METHODS: All discharges from German hospitals from 2016 to 2021.
METHODS: Full term neonates with birth asphyxia (ICD-10 code: P21) admitted to a pediatric department on their first day of life.
METHODS: Postnatal transfer to a pediatric department within 24 h of admission to an external hospital.
RESULTS: In-hospital death; secondary outcomes: seizures and pediatric complex chronic conditions category (PCCC) ≥ 2.
RESULTS: Of 11,703,800 pediatric cases, 25,914 fulfilled the inclusion criteria. TNs had higher proportions of organ dysfunction, TH, organ replacement therapies, and neurological sequelae in spite of slightly lower proportions of maternal risk factors. In TNs, the adjusted odds ratios (OR) for death, seizures, and PCCC ≥ 2 were 4.08 ((95% confidence interval 3.41-4.89), 2.99 (2.65-3.38), and 1.76 (1.52-2.05), respectively. A subgroup analysis among infants receiving TH (n = 3,283) found less pronounced adjusted ORs for death (1.67 (1.29-2.17)) and seizures (1.26 (1.07-1.48)) and inverse effects for PCCC ≥ 2 (0.81 (0.64-1.02)) in TNs.
CONCLUSIONS: This comprehensive nationwide study found increased odds for adverse outcomes in neonates with BA who were transferred to another facility within 24 h of hospital admission. Closely linking obstetrical units to a pediatric department and balancing geographical coverage of different levels of care facilities might help to minimize risks for postnatal emergency transfer and optimize perinatal care.
摘要：
目的：在出生窒息（BA）和缺氧缺血性脑病的新生儿中，治疗性低温（TH），在六个小时内启动，是预防继发性脑损伤的唯一安全和既定的神经保护措施。在TH中心以外出生的婴儿延迟了冷却的机会。
目的：比较住院死亡率，癫痫发作的发生，以及BA新生儿出院时的功能状态，取决于出生后在入院后24小时内转移到另一家医院治疗（转移（TN）与非转移新生儿（NTN））。
方法：全国范围的回顾性队列研究，来自综合医院数据集，使用国际疾病分类代码，第十次修改（ICD-10）。从诊断和程序代码中检索临床和结果信息。进行分层多水平逻辑回归建模，以量化出生后转移对目标结局的影响。
方法：2016年至2021年德国医院的所有出院。
方法：出生窒息的足月新生儿（ICD-10代码：P21）在出生后的第一天入院儿科。
方法：出生后在入院后24小时内转移到儿科。
结果：住院死亡；次要结果：癫痫发作和儿科复杂慢性疾病类别（PCCC）≥2。
结果：在11,703,800例儿科病例中，25,914符合纳入标准。TNs有较高比例的器官功能障碍，TH,器官替代疗法,尽管母体风险因素的比例略低，但神经系统后遗症。在TNs中，死亡的调整后赔率比(OR)，癫痫发作,PCCC≥2为4.08((95%置信区间3.41-4.89)，2.99（2.65-3.38），和1.76（1.52-2.05），分别。在接受TH（n=3,283）的婴儿中进行的亚组分析发现，对于死亡（1.67（1.29-2.17））和癫痫发作（1.26（1.07-1.48））的校正OR不太明显，对于PCCC≥2（0.81（0.64-1.02））在TNs中。结论和相关性这项全面的全国性研究发现，在入院后24小时内转移到另一个机构的BA新生儿中，不良结局的几率增加。将产科单元与儿科紧密联系，并平衡不同级别护理设施的地理覆盖范围，可能有助于最大程度地减少产后紧急转移的风险并优化围产期护理。
目的：比较住院死亡率，癫痫发作的发生，以及BA新生儿出院时的功能状态，取决于出生后在入院后24小时内转移到另一家医院治疗（转移（TN）与非转移新生儿（NTN））。
方法：全国范围的回顾性队列研究，来自综合医院数据集，使用国际疾病分类代码，第十次修改（ICD-10）。从诊断和程序代码中检索临床和结果信息。进行分层多水平逻辑回归建模，以量化出生后转移对目标结局的影响。
方法：2016年至2021年德国医院的所有出院。
方法：出生窒息的足月新生儿（ICD-10代码：P21）在出生后的第一天入院儿科。
方法：出生后在入院后24小时内转移到儿科。
结果：住院死亡；次要结果：癫痫发作和儿科复杂慢性疾病类别（PCCC）≥2。
结果：在11,703,800例儿科病例中，25,914符合纳入标准。TNs有较高比例的器官功能障碍，TH,器官替代疗法,尽管母体风险因素的比例略低，但神经系统后遗症。在TNs中，死亡的调整后赔率比(OR)，癫痫发作,PCCC≥2为4.08((95%置信区间3.41-4.89)，2.99（2.65-3.38），和1.76（1.52-2.05），分别。在接受TH（n=3,283）的婴儿中进行的亚组分析发现，对于死亡（1.67（1.29-2.17））和癫痫发作（1.26（1.07-1.48））的校正OR不太明显，对于PCCC≥2（0.81（0.64-1.02））在TNs中。结论和相关性这项全面的全国性研究发现，在入院后24小时内转移到另一个机构的BA新生儿中，不良结局的几率增加。将产科单元与儿科紧密联系，并平衡不同级别护理设施的地理覆盖范围，可能有助于最大程度地减少产后紧急转移的风险并优化围产期护理。
