CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2012
Maternal and neonatal separation and mortality associated with concurrent admissions to intensive care units.
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Ray Joel G, Urquia Marcelo L, Berger Howard, Vermeulen Marian J
Аннотация
BACKGROUND: Concurrent admission of a mother and her newborn to separate intensive care units (herein referred to as co-ICU admission), possibly in different centres, can magnify family discord and stress. We examined the prevalence and predictors of mother-infant separation and mortality associated with co-ICU admissions.
METHODS: We completed a population-based study of all 1 023 978 singleton live births in Ontario between Apr. 1, 2002, and Mar. 31, 2010. We included data for maternal-infant pairs that had co-ICU admission (n = 1216), maternal ICU admission only (n = 897), neonatal ICU (NICU) admission only (n = 123 236) or no ICU admission (n = 898 629). The primary outcome measure was mother-infant separation because of interfacility transfer.
RESULTS: The prevalence of co-ICU admissions was 1.2 per 1000 live births and was higher than maternal ICU admissions (0.9 per 1000). Maternal-newborn separation due to interfacility transfer was 30.8 (95% confidence interval [CI] 26.9-35.3) times more common in the co-ICU group than in the no-ICU group and exceeded the prevalence in the maternal ICU group and NICU group. Short-term infant mortality (< 28 days after birth) was higher in the co-ICU group (18.1 per 1000 live births; maternal age-adjusted hazard ratio [HR] 27.8, 95% CI 18.2-42.6) than in the NICU group (7.6 per 1000; age-adjusted HR 11.5, 95% CI 10.4-12.7), relative to 0.7 per 1000 in the no-ICU group. Short-term maternal mortality (< 42 days after delivery) was also higher in the co-ICU group (15.6 per 1000; age-adjusted HR 328.7, 95% CI 191.2-565.2) than in the maternal ICU group (6.7 per 1000; age-adjusted HR 140.0, 95% CI 59.5-329.2) or the NICU group (0.2 per 1000; age-adjusted HR 4.6, 95% CI 2.8-7.4).
INTERPRETATION: Mother-infant pairs in the co-ICU group had the highest prevalence of separation due to interfacility transfer and the highest mortality compared with those in the maternal ICU and NICU groups.
METHODS: We completed a population-based study of all 1 023 978 singleton live births in Ontario between Apr. 1, 2002, and Mar. 31, 2010. We included data for maternal-infant pairs that had co-ICU admission (n = 1216), maternal ICU admission only (n = 897), neonatal ICU (NICU) admission only (n = 123 236) or no ICU admission (n = 898 629). The primary outcome measure was mother-infant separation because of interfacility transfer.
RESULTS: The prevalence of co-ICU admissions was 1.2 per 1000 live births and was higher than maternal ICU admissions (0.9 per 1000). Maternal-newborn separation due to interfacility transfer was 30.8 (95% confidence interval [CI] 26.9-35.3) times more common in the co-ICU group than in the no-ICU group and exceeded the prevalence in the maternal ICU group and NICU group. Short-term infant mortality (< 28 days after birth) was higher in the co-ICU group (18.1 per 1000 live births; maternal age-adjusted hazard ratio [HR] 27.8, 95% CI 18.2-42.6) than in the NICU group (7.6 per 1000; age-adjusted HR 11.5, 95% CI 10.4-12.7), relative to 0.7 per 1000 in the no-ICU group. Short-term maternal mortality (< 42 days after delivery) was also higher in the co-ICU group (15.6 per 1000; age-adjusted HR 328.7, 95% CI 191.2-565.2) than in the maternal ICU group (6.7 per 1000; age-adjusted HR 140.0, 95% CI 59.5-329.2) or the NICU group (0.2 per 1000; age-adjusted HR 4.6, 95% CI 2.8-7.4).
INTERPRETATION: Mother-infant pairs in the co-ICU group had the highest prevalence of separation due to interfacility transfer and the highest mortality compared with those in the maternal ICU and NICU groups.
Предметные рубрики MeSH
AdultAsphyxia NeonatorumCesarean SectionCongenital AbnormalitiesExtraction, ObstetricalFemaleHospital MortalityHumansInfantInfant MortalityInfant, Low Birth WeightInfant, NewbornInfant, Premature, DiseasesIntensive Care UnitsIntensive Care Units, NeonatalKidney DiseasesLength of StayMaternal MortalityObstetrical ForcepsOntarioParityPatient AdmissionPatient TransferPostpartum HemorrhagePre-EclampsiaPregnancyPremature BirthProportional Hazards ModelsRetrospective StudiesRisk Factors