背景:许多报告出生中心新生儿结局的研究使用循证CABC标准,包括出生中心无法接受的危险因素。需要准确比较低风险患者的分娩结局。
方法:使用2018年至2021年的公共自然详细档案数据。Logistic回归,包括调整后和未调整的赔率比,比较新生儿结局(绒毛膜羊膜炎,阿普加得分,复苏,重症监护,癫痫发作,和死亡)在中心和医院之间。协变量包括母体糖尿病,身体质量指数,年龄,奇偶校验,和人口特征。
结果:样本包括8,738,711例分娩(医院为8,698,432(99.53%),出生中心为40,279(0.46%))。新生儿死亡(aOR1.037;95%CI[0.515,2.088];p值0.918)或癫痫发作(aOR0.666;95%CI[0.315,1.411];p值0.289)无显著差异。与医院相比,分娩中心的发病率指标没有显着差异或不太可能发生绒毛膜羊膜炎(aOR0.032;95%CI[0.020,0.052];p值<0.001),阿普加评分<4(aOR0.814,95%CI[0.638,1.039],p值0.099),阿普加评分<7(aOR1.075,95%CI[0.979,1.180],p值0.130),通风>6小时(aOR0.349;[0.281,0.433],p值<0.001),和重症监护入院(aOR0.356;95%CI[0.328,0.386],p值<0.001)。与医院相比,分娩中心辅助新生儿通气<6小时的几率更高(aOR1.373;95%CI[1.293,1.457],p值<0.001)。
结论:新生儿死亡和癫痫发作在独立分娩中心和医院之间没有显著差异。绒毛膜羊膜炎,出生中心的Apgar评分<4,重症监护住院的可能性较小。
BACKGROUND: Many studies reporting neonatal outcomes in birth centers include births with risk factors not acceptable for birth center care using the evidence-based CABC criteria. Accurate comparisons of outcomes by birth setting for low-risk patients are needed.
METHODS: Data from the public Natality Detailed File from 2018 to 2021 were used. Logistic regression, including adjusted and unadjusted odds ratios, compared neonatal outcomes (chorioamnionitis, Apgar scores, resuscitation, intensive care, seizures, and death) between centers and hospitals. Covariates included maternal diabetes, body mass index, age, parity, and demographic characteristics.
RESULTS: The sample included 8,738,711 births (8,698,432 (99.53%) in hospitals and 40,279 (0.46%) in birth centers). There were no significant differences in neonatal deaths (aOR 1.037; 95% CI [0.515, 2.088]; p-value 0.918) or seizures (aOR 0.666; 95% CI [0.315, 1.411]; p-value 0.289). Measures of morbidity either not significantly different or less likely to occur in birth centers compared to hospitals included chorioamnionitis (aOR 0.032; 95% CI [0.020, 0.052]; p-value < 0.001), Apgar score < 4 (aOR 0.814, 95% CI [0.638, 1.039], p-value 0.099), Apgar score < 7 (aOR 1.075, 95% CI [0.979, 1.180], p-value 0.130), ventilation >6 h (aOR 0.349; [0.281,0.433], p-value < 0.001), and intensive care admission (aOR 0.356; 95% CI [0.328, 0.386], p-value < 0.001). Birth centers had higher odds of assisted neonatal ventilation for <6 h as compared to hospitals (aOR 1.373; 95% CI [1.293, 1.457], p-value < 0.001).
CONCLUSIONS: Neonatal deaths and seizures were not significantly different between freestanding birth centers and hospitals. Chorioamnionitis, Apgar scores < 4, and intensive care admission were less likely to occur in birth centers.