RESUMO
Maternity unit closures in France have increased travel time for pregnant women in rural areas. We assessed the impact of travel time to the closest unit on perinatal outcomes and care in Burgundy using multilevel analyses of data on deliveries from 2000 to 2009. A travel time of 30min or more increased risks of fetal heart rate anomalies, meconium-stained amniotic fluid, out-of-hospital births, and pregnancy hospitalizations; a positive but non-significant gradient existed between travel time and perinatal mortality. The effects of long travel distances on perinatal outcomes and care should be factored into closure decisions.
Assuntos
Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Serviços de Saúde Materna/provisão & distribuição , Assistência Perinatal , Adolescente , Adulto , Bases de Dados Factuais , Feminino , França/epidemiologia , Fechamento de Instituições de Saúde , Humanos , Prontuários Médicos , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/epidemiologia , Serviços de Saúde Rural/provisão & distribuição , Adulto JovemRESUMO
BACKGROUND: The extensive use of broad-spectrum antibiotics has been associated with major changes in the spectrum of organisms involved in early-onset neonatal infection (EONI), their susceptibility to antibiotics, or both. Therefore, guidelines for a more rational use of antibiotics in neonates have been developed. We conducted a population-based observational study to assess the effectiveness and compliance with restrictive guidelines for the antibiotic therapy in EONI. METHODS: Neonates receiving antibiotics within 72 hours of life were identified prospectively by population-based surveillance in the 18 hospitals of Burgundy, between February 2002 and June 2003. They were treated in accordance with guidelines limiting the use of broad-spectrum antibiotics and shortening the treatment duration. Each neonate included was evaluated for 60 days after birth. An unfavorable outcome was defined as death related to EONI or late-onset infection. RESULTS: Of the 25,480 infants born during the study period, 1012 received antibiotics at birth. Of these 1012 infants, 39 were definitely infected (septicemia), 288 clinically infected and 685 not infected. The EONI cure rate was 96.8% without infectious relapse. Forty-five infants received a second course of antibiotic therapy. Birth weight (OR: 5.6; 95% CI: 2.2-14.1), mechanical ventilation (OR: 4.1; 95% CI: 1.3-13.1), central venous catheterization (OR: 16.1; 95% CI: 1.8-141.9), and antibiotic therapy duration (OR: 2.5; 95% CI: 1.1-5.5) were independently associated with late-onset infection. CONCLUSION: Reducing the antibiotic therapy duration does not increase the risk of infectious relapse and may decrease the incidence of late-onset infection.
Assuntos
Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Guias de Prática Clínica como Assunto , Idade de Início , Peso ao Nascer , Cateterismo Venoso Central , Esquema de Medicação , Humanos , Recém-Nascido , Razão de Chances , Respiração Artificial , Fatores de RiscoRESUMO
BACKGROUND: The efficacy of palivizumab prophylaxis after bronchopulmonary dysplasia (BPD) has been demonstrated in a single placebo-controlled trial. Concern has emerged about the degree of efficacy of palivizumab. This study was designed to determine the efficacy of administration of palivizumab to premature infants with a gestational age =32 weeks, a past history of BPD and younger than 6 months of age at the start of the epidemic. METHODS: Prospective observational study of respiratory syncytial virus (RSV) bronchiolitis requiring hospitalization in Burgundy (12 hospitals) from December 1 to April 30 of the next year during 3 successive epidemic seasons (1999-2000, 2000-2001 and 2001-2002). The regional perinatal database provided perinatal epidemiologic characteristics of the population as a whole and of cohorts of children at risk for severe RSV infection born between April 15 and January 31 of the following year. Palivizumab was used in the 2000-2001 and 2001-2002 periods only. RESULTS: The 3 epidemics included respectively 377, 310 and 328 children born during April 15 to January 31 of the following year. The 3 epidemics differed significantly by the proportion of severely premature infants with BPD (3.2% versus 0.7 and 0.3%). In the cohort of severely premature infants with BPD born in 1999-2000, 2000-2001 and 2001-2002, the hospitalization rate for RSV bronchiolitis decreased significantly from 12 of 26 to 2 of 17 and 1 of 26 (46.2% versus 11.8 and 3.8%; P < 0.01). Sixteen of 17 and 23 of 26 premature infants with a gestational age =32 weeks and with BPD had been treated with palivizumab in the years 2000-2001 and 2001-2002. CONCLUSIONS: This study strongly supports the efficacy of prevention of RSV bronchiolitis by palivizumab in severely premature infants with BPD.