Why birthplace still matters for infants born before 32 weeks: Infant mortality associated with birth at 22-31 weeks' gestation in non-tertiary hospitals in Victoria over two decades
Background Very preterm infants born in non‐tertiary hospitals (‘outborn’) are known to have higher mortality rates compared with infants ‘inborn’ in tertiary centres. Aim The aim of this study was to report changes over time in the incidence of outborn livebirths, 22–31 weeks and infant mortality r...
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| Veröffentlicht in: | Australian & New Zealand journal of obstetrics & gynaecology 2015-04, Vol.55 (2), p.163-169 |
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| container_title | Australian & New Zealand journal of obstetrics & gynaecology |
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| creator | Boland, Rosemarie Anne Dawson, Jennifer Anne Davis, Peter Graham Doyle, Lex William |
| description | Background
Very preterm infants born in non‐tertiary hospitals (‘outborn’) are known to have higher mortality rates compared with infants ‘inborn’ in tertiary centres.
Aim
The aim of this study was to report changes over time in the incidence of outborn livebirths, 22–31 weeks and infant mortality rates for outborn compared with inborn births.
Methods
We conducted a population‐based cohort study of consecutive livebirths, 22–31 weeks’ gestation in Victoria from 1990 to 2009. The relationship between birthplace, gestational age, birthweight, sex and infant mortality were analysed by logistic regression.
Results
There were 13,760 livebirths, 22–31 weeks: 14% were outborn. The proportion of outborn livebirths fell from 19% in 1991 to a nadir of 9% in 1997, but climbed to 17% by 2009. At all times, outborns had higher mortality rates compared with inborns. The overall infant mortality rate was 250.6 per 1000 outborn compared with 113.3 per 1000 inborn livebirths (adjusted odds ratio (aOR) 2.76 (95% CI 2.32, 3.27, P |
| doi_str_mv | 10.1111/ajo.12313 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1677379349</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1677379349</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3633-faf451ada7d05dc5910c53b71e814fa9e16edae5997968abf329660d0a3783243</originalsourceid><addsrcrecordid>eNp1kc9u1DAQhy0EokvhwAuguQGHtHacf-ZWFShFq_aybHuzJsmEdZvEi-1l2bfhMTjzZLjNtjd8seT55puxfoy9FvxIxHOMN_ZIpFLIJ2wmslIlVVpdP2UzznmWVEVRHLAX3t9wLlQusufsIM1VKjjPZ-zP1WoHtXFhte6xIfDB9D0MGAI5D511YMYOx-Chtm6EmuITgUz__t4S3foPcH5fhsG6gL0JO0DvbWMwUAtbE1aTHDBAmiZS7PvewnfyAYOxYxwAox2TODAYdDtYWb82UebvKkvTBOsMgv1JDsLWQksNtuRfsmddZOjV_j5k3z5_Wpx-SeaXZ-enJ_OkkYWUSYddlgtssWx53ja5ErzJZV0KqkTWoSJRUIuUK1WqosK6k6kqCt5ylGUl00wesneTd-3sj01cWg_GN9T3OJLdeC2KspSlkpmK6PsJbZz13lGn184M8UtacH0XlI5B6fugIvtmr93UA7WP5EMyETiegK3pafd_kz75evmgTKYO4wP9euxAd6uLuGKury7O9OJ6Mf94sZzrpfwHP6WwxA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1677379349</pqid></control><display><type>article</type><title>Why birthplace still matters for infants born before 32 weeks: Infant mortality associated with birth at 22-31 weeks' gestation in non-tertiary hospitals in Victoria over two decades</title><source>MEDLINE</source><source>Wiley Journals</source><creator>Boland, Rosemarie Anne ; Dawson, Jennifer Anne ; Davis, Peter Graham ; Doyle, Lex William</creator><creatorcontrib>Boland, Rosemarie Anne ; Dawson, Jennifer Anne ; Davis, Peter Graham ; Doyle, Lex William</creatorcontrib><description>Background
Very preterm infants born in non‐tertiary hospitals (‘outborn’) are known to have higher mortality rates compared with infants ‘inborn’ in tertiary centres.
Aim
The aim of this study was to report changes over time in the incidence of outborn livebirths, 22–31 weeks and infant mortality rates for outborn compared with inborn births.
Methods
We conducted a population‐based cohort study of consecutive livebirths, 22–31 weeks’ gestation in Victoria from 1990 to 2009. The relationship between birthplace, gestational age, birthweight, sex and infant mortality were analysed by logistic regression.
Results
There were 13,760 livebirths, 22–31 weeks: 14% were outborn. The proportion of outborn livebirths fell from 19% in 1991 to a nadir of 9% in 1997, but climbed to 17% by 2009. At all times, outborns had higher mortality rates compared with inborns. The overall infant mortality rate was 250.6 per 1000 outborn compared with 113.3 per 1000 inborn livebirths (adjusted odds ratio (aOR) 2.76 (95% CI 2.32, 3.27, P < 0.001). There were no differences between outborn and inborn mortality risks for 22‐week livebirths (OR 7.04, 95% CI 0.87, 56.8, P = 0.067), but there were at 23–27 weeks (aOR 3.16, 95% CI 2.52, 3.96, P < 0.001) and at 28–31 weeks (aOR 1.66, 95% CI 1.19, 2.31, P = 0.003). Over time, mortality rates fell for inborn 23–27 week infants. Mortality rates fell for outborn 23–27 week infants in 1990–2005, but rose in 2006–2009.
Conclusions
Outborn livebirths at 22–31 weeks’ gestation occur too frequently and are associated with a significantly increased risk of mortality. Strategies to reduce outborn livebirths are required.</description><identifier>ISSN: 0004-8666</identifier><identifier>EISSN: 1479-828X</identifier><identifier>DOI: 10.1111/ajo.12313</identifier><identifier>PMID: 25921005</identifier><language>eng</language><publisher>Australia: Blackwell Publishing Ltd</publisher><subject>Birth Weight ; Female ; Gestational Age ; Hospitals - statistics & numerical data ; Humans ; Incidence ; Infant ; infant mortality ; Infant, Newborn ; Live Birth ; Male ; neonatal mortality ; perinatal care ; Perinatal Mortality - trends ; Premature Birth - mortality ; prematurity ; Tertiary Care Centers - statistics & numerical data ; very preterm infant ; Victoria - epidemiology</subject><ispartof>Australian & New Zealand journal of obstetrics & gynaecology, 2015-04, Vol.55 (2), p.163-169</ispartof><rights>2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists</rights><rights>2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3633-faf451ada7d05dc5910c53b71e814fa9e16edae5997968abf329660d0a3783243</citedby><cites>FETCH-LOGICAL-c3633-faf451ada7d05dc5910c53b71e814fa9e16edae5997968abf329660d0a3783243</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fajo.12313$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fajo.12313$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25921005$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boland, Rosemarie Anne</creatorcontrib><creatorcontrib>Dawson, Jennifer Anne</creatorcontrib><creatorcontrib>Davis, Peter Graham</creatorcontrib><creatorcontrib>Doyle, Lex William</creatorcontrib><title>Why birthplace still matters for infants born before 32 weeks: Infant mortality associated with birth at 22-31 weeks' gestation in non-tertiary hospitals in Victoria over two decades</title><title>Australian & New Zealand journal of obstetrics & gynaecology</title><addtitle>Aust N Z J Obstet Gynaecol</addtitle><description>Background
Very preterm infants born in non‐tertiary hospitals (‘outborn’) are known to have higher mortality rates compared with infants ‘inborn’ in tertiary centres.
Aim
The aim of this study was to report changes over time in the incidence of outborn livebirths, 22–31 weeks and infant mortality rates for outborn compared with inborn births.
Methods
We conducted a population‐based cohort study of consecutive livebirths, 22–31 weeks’ gestation in Victoria from 1990 to 2009. The relationship between birthplace, gestational age, birthweight, sex and infant mortality were analysed by logistic regression.
Results
There were 13,760 livebirths, 22–31 weeks: 14% were outborn. The proportion of outborn livebirths fell from 19% in 1991 to a nadir of 9% in 1997, but climbed to 17% by 2009. At all times, outborns had higher mortality rates compared with inborns. The overall infant mortality rate was 250.6 per 1000 outborn compared with 113.3 per 1000 inborn livebirths (adjusted odds ratio (aOR) 2.76 (95% CI 2.32, 3.27, P < 0.001). There were no differences between outborn and inborn mortality risks for 22‐week livebirths (OR 7.04, 95% CI 0.87, 56.8, P = 0.067), but there were at 23–27 weeks (aOR 3.16, 95% CI 2.52, 3.96, P < 0.001) and at 28–31 weeks (aOR 1.66, 95% CI 1.19, 2.31, P = 0.003). Over time, mortality rates fell for inborn 23–27 week infants. Mortality rates fell for outborn 23–27 week infants in 1990–2005, but rose in 2006–2009.
Conclusions
Outborn livebirths at 22–31 weeks’ gestation occur too frequently and are associated with a significantly increased risk of mortality. Strategies to reduce outborn livebirths are required.</description><subject>Birth Weight</subject><subject>Female</subject><subject>Gestational Age</subject><subject>Hospitals - statistics & numerical data</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infant</subject><subject>infant mortality</subject><subject>Infant, Newborn</subject><subject>Live Birth</subject><subject>Male</subject><subject>neonatal mortality</subject><subject>perinatal care</subject><subject>Perinatal Mortality - trends</subject><subject>Premature Birth - mortality</subject><subject>prematurity</subject><subject>Tertiary Care Centers - statistics & numerical data</subject><subject>very preterm infant</subject><subject>Victoria - epidemiology</subject><issn>0004-8666</issn><issn>1479-828X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc9u1DAQhy0EokvhwAuguQGHtHacf-ZWFShFq_aybHuzJsmEdZvEi-1l2bfhMTjzZLjNtjd8seT55puxfoy9FvxIxHOMN_ZIpFLIJ2wmslIlVVpdP2UzznmWVEVRHLAX3t9wLlQusufsIM1VKjjPZ-zP1WoHtXFhte6xIfDB9D0MGAI5D511YMYOx-Chtm6EmuITgUz__t4S3foPcH5fhsG6gL0JO0DvbWMwUAtbE1aTHDBAmiZS7PvewnfyAYOxYxwAox2TODAYdDtYWb82UebvKkvTBOsMgv1JDsLWQksNtuRfsmddZOjV_j5k3z5_Wpx-SeaXZ-enJ_OkkYWUSYddlgtssWx53ja5ErzJZV0KqkTWoSJRUIuUK1WqosK6k6kqCt5ylGUl00wesneTd-3sj01cWg_GN9T3OJLdeC2KspSlkpmK6PsJbZz13lGn184M8UtacH0XlI5B6fugIvtmr93UA7WP5EMyETiegK3pafd_kz75evmgTKYO4wP9euxAd6uLuGKury7O9OJ6Mf94sZzrpfwHP6WwxA</recordid><startdate>201504</startdate><enddate>201504</enddate><creator>Boland, Rosemarie Anne</creator><creator>Dawson, Jennifer Anne</creator><creator>Davis, Peter Graham</creator><creator>Doyle, Lex William</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201504</creationdate><title>Why birthplace still matters for infants born before 32 weeks: Infant mortality associated with birth at 22-31 weeks' gestation in non-tertiary hospitals in Victoria over two decades</title><author>Boland, Rosemarie Anne ; Dawson, Jennifer Anne ; Davis, Peter Graham ; Doyle, Lex William</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3633-faf451ada7d05dc5910c53b71e814fa9e16edae5997968abf329660d0a3783243</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Birth Weight</topic><topic>Female</topic><topic>Gestational Age</topic><topic>Hospitals - statistics & numerical data</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infant</topic><topic>infant mortality</topic><topic>Infant, Newborn</topic><topic>Live Birth</topic><topic>Male</topic><topic>neonatal mortality</topic><topic>perinatal care</topic><topic>Perinatal Mortality - trends</topic><topic>Premature Birth - mortality</topic><topic>prematurity</topic><topic>Tertiary Care Centers - statistics & numerical data</topic><topic>very preterm infant</topic><topic>Victoria - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boland, Rosemarie Anne</creatorcontrib><creatorcontrib>Dawson, Jennifer Anne</creatorcontrib><creatorcontrib>Davis, Peter Graham</creatorcontrib><creatorcontrib>Doyle, Lex William</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Australian & New Zealand journal of obstetrics & gynaecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boland, Rosemarie Anne</au><au>Dawson, Jennifer Anne</au><au>Davis, Peter Graham</au><au>Doyle, Lex William</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Why birthplace still matters for infants born before 32 weeks: Infant mortality associated with birth at 22-31 weeks' gestation in non-tertiary hospitals in Victoria over two decades</atitle><jtitle>Australian & New Zealand journal of obstetrics & gynaecology</jtitle><addtitle>Aust N Z J Obstet Gynaecol</addtitle><date>2015-04</date><risdate>2015</risdate><volume>55</volume><issue>2</issue><spage>163</spage><epage>169</epage><pages>163-169</pages><issn>0004-8666</issn><eissn>1479-828X</eissn><abstract>Background
Very preterm infants born in non‐tertiary hospitals (‘outborn’) are known to have higher mortality rates compared with infants ‘inborn’ in tertiary centres.
Aim
The aim of this study was to report changes over time in the incidence of outborn livebirths, 22–31 weeks and infant mortality rates for outborn compared with inborn births.
Methods
We conducted a population‐based cohort study of consecutive livebirths, 22–31 weeks’ gestation in Victoria from 1990 to 2009. The relationship between birthplace, gestational age, birthweight, sex and infant mortality were analysed by logistic regression.
Results
There were 13,760 livebirths, 22–31 weeks: 14% were outborn. The proportion of outborn livebirths fell from 19% in 1991 to a nadir of 9% in 1997, but climbed to 17% by 2009. At all times, outborns had higher mortality rates compared with inborns. The overall infant mortality rate was 250.6 per 1000 outborn compared with 113.3 per 1000 inborn livebirths (adjusted odds ratio (aOR) 2.76 (95% CI 2.32, 3.27, P < 0.001). There were no differences between outborn and inborn mortality risks for 22‐week livebirths (OR 7.04, 95% CI 0.87, 56.8, P = 0.067), but there were at 23–27 weeks (aOR 3.16, 95% CI 2.52, 3.96, P < 0.001) and at 28–31 weeks (aOR 1.66, 95% CI 1.19, 2.31, P = 0.003). Over time, mortality rates fell for inborn 23–27 week infants. Mortality rates fell for outborn 23–27 week infants in 1990–2005, but rose in 2006–2009.
Conclusions
Outborn livebirths at 22–31 weeks’ gestation occur too frequently and are associated with a significantly increased risk of mortality. Strategies to reduce outborn livebirths are required.</abstract><cop>Australia</cop><pub>Blackwell Publishing Ltd</pub><pmid>25921005</pmid><doi>10.1111/ajo.12313</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0004-8666 |
| ispartof | Australian & New Zealand journal of obstetrics & gynaecology, 2015-04, Vol.55 (2), p.163-169 |
| issn | 0004-8666 1479-828X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1677379349 |
| source | MEDLINE; Wiley Journals |
| subjects | Birth Weight Female Gestational Age Hospitals - statistics & numerical data Humans Incidence Infant infant mortality Infant, Newborn Live Birth Male neonatal mortality perinatal care Perinatal Mortality - trends Premature Birth - mortality prematurity Tertiary Care Centers - statistics & numerical data very preterm infant Victoria - epidemiology |
| title | Why birthplace still matters for infants born before 32 weeks: Infant mortality associated with birth at 22-31 weeks' gestation in non-tertiary hospitals in Victoria over two decades |
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