Measuring severe neonatal morbidity using hospital discharge data in France.

Autor: Lebreton E; INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.; Non Communicable Diseases and Trauma Division, Santé publique France, The National Public Health Agency, Saint-Maurice, France.; Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Saint-Denis, France., Menguy C; Non Communicable Diseases and Trauma Division, Santé publique France, The National Public Health Agency, Saint-Maurice, France.; Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Saint-Denis, France., Fresson J; INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.; Department of Medical Information, Maternity of University Hospital - CHRU Nancy, Nancy, France., Egorova NN; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA., Crenn Hebert C; Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Saint-Denis, France.; Maternity Unit, University Hospital (APHP), Hôpital Louis Mourier, Colombes, France., Zeitlin J; INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
Jazyk: angličtina
Zdroj: Paediatric and perinatal epidemiology [Paediatr Perinat Epidemiol] 2022 Mar; Vol. 36 (2), pp. 190-201. Date of Electronic Publication: 2021 Nov 19.
DOI: 10.1111/ppe.12816
Abstrakt: Background: Measuring infant health at birth is key for surveillance and research in obstetrics and neonatology, but there is no international consensus on morbidity indicators. The Neonatal Adverse Outcome Indicator (NAOI) is a composite indicator, developed in Australia, which measures the burden of severe neonatal morbidity using hospital discharge data.
Objective: To evaluate the applicability of the NAOI in France for surveillance and research.
Methods: We constituted a cohort of live births ≥24 weeks' gestational age in Metropolitan France from 2014 to 2015 using hospital discharge, insurance claims and cause of death data. Outlier hospitals were identified using funnel plots of standardised morbidity ratios (SMR), and their coding patterns were assessed. We compared the NAOI and its component codes with published Australian and English data and estimated unadjusted and adjusted risk ratios for known risk factors for neonatal morbidity.
Results: We included 1,459,123 births (511 hospitals). Twenty-eight hospitals had SMR above funnel plot control limits. Newborns with NAOI morbidities in these hospitals had lower mortality and shorter stays than in other hospitals. Amongst within-limit hospitals, NAOI prevalence was 4.8%, comparable to Australia (4.6%) and England (5.4%). Most individual components had a similar prevalence, with the exception of respiratory support, intravenous fluid procedures and infection. NAOI was lowest at 39 weeks (2.2%) with higher risks for maternal age ≥40 (relative risk [RR] 1.47, 95% confidence interval [CI] 1.42, 1.51), state medical insurance (RR 1.60, 95% CI 1.52, 1.68), male sex (RR 1.21, 95% CI 1.19, 1.23) and birthweight <3 rd percentile (RR 4.60, 95% CI 4.51, 4.69).
Conclusions: The NAOI provides valuable information on population prevalence of severe neonatal morbidity and its risk factors. Whilst the prevalence was similar in high-income countries with comparable neonatal mortality levels, ensuring valid comparisons between countries and hospitals will require further work to harmonize coding procedures, especially for infection and respiratory morbidity.
(© 2021 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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