Objective

Evaluate the relationship of neonatal unit level of care (LOC) and volume with mortality or morbidity in moderate-late preterm (MLP) (32–36 weeks’ gestation) infants.

Design

Retrospective cohort study of 650,865 inborn MLP infants in 4976 hospitals-years using 2003–2015 linked administrative data from 4 states. Exposure was combined neonatal LOC and MLP annual volume. The primary outcome was death or morbidity (respiratory distress syndrome, severe intraventricular hemorrhage, necrotizing enterocolitis, sepsis, infection, pneumothorax, extreme length of stay) with components as secondary outcomes. Poisson regression models adjusted for patient characteristics with a random effect for unit were used.

Results

In adjusted models, high-volume level 2 units had a lower risk of the primary outcome compared to low-volume level 3 units (aIRR 0.90 [95% CI 0.83–0.98] vs. aIRR 1.13 [95% CI 1.03–1.24], p < 0.001)

Conclusion

MLP infants had improved outcomes in high-volume level 2 units compared to low-volume level 3 units in adjusted analysis.

中文翻译：

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数量和新生儿护理水平对中晚期早产儿结局的影响

客观的

评估新生儿单位护理水平 (LOC) 和数量与中晚期早产儿 (MLP)（妊娠 32-36 周）婴儿死亡率或发病率的关系。

设计

使用 2003 年至 2015 年 4 个州的相关行政数据，对 4976 个医院年的 650,865 名出生 MLP 婴儿进行回顾性队列研究。暴露量是新生儿 LOC 和 MLP 年量的组合。主要结局是死亡或发病（呼吸窘迫综合征、严重脑室内出血、坏死性小肠结肠炎、败血症、感染、气胸、超长住院时间），其他结局为次要结局。使用根据患者特征调整的泊松回归模型，并具有单位随机效应。

结果

在调整后的模型中，与低容量 3 级单位相比，高容量 2 级单位的主要结局风险较低（aIRR 0.90 [95% CI 0.83–0.98] 与 aIRR 1.13 [95% CI 1.03–1.24]，p  < 0.001)

结论

在调整分析中，与低容量 3 级单元相比，MLP 婴儿在高容量 2 级单元中的结果有所改善。