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Neonatal admission and mortality in babies born in UK alongside midwifery units: a national population-based case-control study using the UK Midwifery Study System (UKMidSS)

OBJECTIVES: To determine the incidence of and risk factors for neonatal unit admission, intrapartum stillbirth or neonatal death without admission, and describe outcomes, in babies born in an alongside midwifery unit (AMU). DESIGN: National population-based case-control study. METHOD: We used the UK...

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Autores principales: Rowe, Rachel, Soe, Aung, Knight, Marian, Kurinczuk, Jennifer J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907574/
https://www.ncbi.nlm.nih.gov/pubmed/33127735
http://dx.doi.org/10.1136/archdischild-2020-319099
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author Rowe, Rachel
Soe, Aung
Knight, Marian
Kurinczuk, Jennifer J
author_facet Rowe, Rachel
Soe, Aung
Knight, Marian
Kurinczuk, Jennifer J
author_sort Rowe, Rachel
collection PubMed
description OBJECTIVES: To determine the incidence of and risk factors for neonatal unit admission, intrapartum stillbirth or neonatal death without admission, and describe outcomes, in babies born in an alongside midwifery unit (AMU). DESIGN: National population-based case-control study. METHOD: We used the UK Midwifery Study System to identify and collect data about 1041 women who gave birth in AMUs, March 2017 to February 2018, whose babies were admitted to a neonatal unit or died (cases) and 1984 controls from the same AMUs. We used multivariable logistic regression, generating adjusted OR (aOR) with 95% CIs, to investigate maternal and intrapartum factors associated with neonatal admission or mortality. RESULTS: The incidence of neonatal admission or mortality following birth in an AMU was 1.2%, comprising neonatal admission (1.2%) and mortality (0.01%). White ‘other’ ethnicity (aOR=1.28; 95% CI=1.01 to 1.63); nulliparity (aOR=2.09; 95% CI=1.78 to 2.45); ≥2 previous pregnancies ≥24 weeks’ gestation (aOR=1.38; 95% CI=1.10 to 1.74); male sex (aOR=1.46; 95% CI=1.23 to 1.75); maternal pregnancy problem (aOR=1.40; 95% CI=1.03 to 1.90); prolonged (aOR=1.42; 95% CI=1.01 to 2.01) or unrecorded (aOR=1.38; 95% CI=1.05 to 1.81) second stage duration; opiate use (aOR=1.31; 95% CI=1.02 to 1.68); shoulder dystocia (aOR=5.06; 95% CI=3.00 to 8.52); birth weight <2500 g (aOR=4.12; 95% CI=1.97 to 8.60), 4000–4999 g (aOR=1.64; 95% CI=1.25 to 2.14) and ≥4500 g (aOR=2.10; 95% CI=1.17 to 3.76), were independently associated with neonatal admission or mortality. Among babies admitted (n=1038), 18% received intensive care. Nine babies died, six following neonatal admission. Sepsis (52%) and respiratory distress (42%) were the most common discharge diagnoses. CONCLUSIONS: The results of this study are in line with other evidence on risk factors for neonatal admission, and reassuring in terms of the quality and safety of care in AMUs.
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spelling pubmed-79075742021-03-11 Neonatal admission and mortality in babies born in UK alongside midwifery units: a national population-based case-control study using the UK Midwifery Study System (UKMidSS) Rowe, Rachel Soe, Aung Knight, Marian Kurinczuk, Jennifer J Arch Dis Child Fetal Neonatal Ed Original Research OBJECTIVES: To determine the incidence of and risk factors for neonatal unit admission, intrapartum stillbirth or neonatal death without admission, and describe outcomes, in babies born in an alongside midwifery unit (AMU). DESIGN: National population-based case-control study. METHOD: We used the UK Midwifery Study System to identify and collect data about 1041 women who gave birth in AMUs, March 2017 to February 2018, whose babies were admitted to a neonatal unit or died (cases) and 1984 controls from the same AMUs. We used multivariable logistic regression, generating adjusted OR (aOR) with 95% CIs, to investigate maternal and intrapartum factors associated with neonatal admission or mortality. RESULTS: The incidence of neonatal admission or mortality following birth in an AMU was 1.2%, comprising neonatal admission (1.2%) and mortality (0.01%). White ‘other’ ethnicity (aOR=1.28; 95% CI=1.01 to 1.63); nulliparity (aOR=2.09; 95% CI=1.78 to 2.45); ≥2 previous pregnancies ≥24 weeks’ gestation (aOR=1.38; 95% CI=1.10 to 1.74); male sex (aOR=1.46; 95% CI=1.23 to 1.75); maternal pregnancy problem (aOR=1.40; 95% CI=1.03 to 1.90); prolonged (aOR=1.42; 95% CI=1.01 to 2.01) or unrecorded (aOR=1.38; 95% CI=1.05 to 1.81) second stage duration; opiate use (aOR=1.31; 95% CI=1.02 to 1.68); shoulder dystocia (aOR=5.06; 95% CI=3.00 to 8.52); birth weight <2500 g (aOR=4.12; 95% CI=1.97 to 8.60), 4000–4999 g (aOR=1.64; 95% CI=1.25 to 2.14) and ≥4500 g (aOR=2.10; 95% CI=1.17 to 3.76), were independently associated with neonatal admission or mortality. Among babies admitted (n=1038), 18% received intensive care. Nine babies died, six following neonatal admission. Sepsis (52%) and respiratory distress (42%) were the most common discharge diagnoses. CONCLUSIONS: The results of this study are in line with other evidence on risk factors for neonatal admission, and reassuring in terms of the quality and safety of care in AMUs. BMJ Publishing Group 2021-03 2020-10-30 /pmc/articles/PMC7907574/ /pubmed/33127735 http://dx.doi.org/10.1136/archdischild-2020-319099 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Research
Rowe, Rachel
Soe, Aung
Knight, Marian
Kurinczuk, Jennifer J
Neonatal admission and mortality in babies born in UK alongside midwifery units: a national population-based case-control study using the UK Midwifery Study System (UKMidSS)
title Neonatal admission and mortality in babies born in UK alongside midwifery units: a national population-based case-control study using the UK Midwifery Study System (UKMidSS)
title_full Neonatal admission and mortality in babies born in UK alongside midwifery units: a national population-based case-control study using the UK Midwifery Study System (UKMidSS)
title_fullStr Neonatal admission and mortality in babies born in UK alongside midwifery units: a national population-based case-control study using the UK Midwifery Study System (UKMidSS)
title_full_unstemmed Neonatal admission and mortality in babies born in UK alongside midwifery units: a national population-based case-control study using the UK Midwifery Study System (UKMidSS)
title_short Neonatal admission and mortality in babies born in UK alongside midwifery units: a national population-based case-control study using the UK Midwifery Study System (UKMidSS)
title_sort neonatal admission and mortality in babies born in uk alongside midwifery units: a national population-based case-control study using the uk midwifery study system (ukmidss)
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907574/
https://www.ncbi.nlm.nih.gov/pubmed/33127735
http://dx.doi.org/10.1136/archdischild-2020-319099
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