| Titre : | Obstetrical volume and early neonatal mortality in preterm infants. (2007) |
| Auteurs : | BARTELS (Dorothee-B) : DEU. Department of Epidemiology. Public Medicine and Healthcare Systems Research. Hannover Medical School. Hannover. ; POETS (Christian-F) : DEU. Department of Neonatology. University of Tiibingen. Tubingen. ; WENZLAFF (Paul) : DEU. Center for Quality and Management in Health Care. Hannover. |
| Type de document : | Article |
| Dans : | European journal of epidemiology (vol. 22, n° 11, 2007) |
| Pagination : | 791-798 |
| Langues: | Anglais |
| Mots-clés : | Obstétrique ; Unité soin ; Structure hospitalière ; Spécialité médicale ; Nouveau né ; Mortalité périnatale ; Mortalité néonatale ; Mortalité ; Epidémiologie ; Prématurité ; Soins hospitaliers ; Hôpital ; Soins ; Qualité soins ; Qualité ; Homme |
| Résumé : | [BDSP. Notice produite par INIST-CNRS YR0x0O0U. Diffusion soumise à autorisation]. Objective : Regionalised perinatal care with antenatal transfer of high risk pregnancies to Level III centres is beneficial. However, levels of care are usually not linked to caseload requirements, which remain a point for discussion. We aimed to investigate the impact of annual delivery volume on early neonatal mortality among very preterm births. Methods : All neonates with gestational age 24-30 weeks, born 1991-1999 in Lower Saxony were included into this population-based cohort study (n=5,083). Large units were defined as caring for more than 1,000 deliveries/year, large NICUs as those with at least 36 annual very low birthweight (<1,500 g, VLBW) admissions. Main outcome criterion was mortality until day 7. Adjusted Odds Ratios (adj. OR) and 95% confidence intervals (CI) were calculated based on generalised estimating equation models, accounting for correlation of individuals within units. Results : Within the first week of life, 20.6% of all neonates deceased ; 10.2% were stillbirths, 3.7% died in the delivery unit, and 6.7% in the NICU. The crude OR for early neonatal mortality after having been delivered in a small delivery unit (excluding stillbirths) was 1.36 (95% CI 1.04-1.78 ; adj. OR 1.16 (0.82-1.63)). It increased to 1.96 (1.54-2.48 ; adj. OR 1.21 (0.86-1.70)) after the inclusion of stillbirths. Conclusion : This study has shown a slight, but non-significant association between obstetrical volume and early neonatal mortality. In future studies the impact of caseload on outcome may become more evident when referring to high-risk patients instead of to the overall number of deliveries. |
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