Abstract
Background
In France, while most babies are delivered at hospital, emergency medical services (EMS) weekly manage calls for unplanned out-of-hospital births. The objective of our study was to describe neonatal morbidity and mortality, defined as death or neonatal intensive care unit hospitalization at Day 7, in a prospective multicentric cohort of unplanned out-of-hospital births.
Methods
We prospectively analyzed out-of-hospital births from 25 prehospital EMS units in France. The primary outcome was neonatal morbidity and mortality, and the secondary outcome was risk factors associated with neonatal morbidity and mortality. A univariate logistic regression was first made, followed by a multivariate logistic regression with backward selection.
Results
From October 2011 to August 2018, a total of 1670 unplanned out-of-hospital births were included. Of these, 1652 (99.2%) were singleton and 1537 (93.5%) had prenatal care. Maternal mean age of the study population was 30 ± 5.5 (range 15 to 48). The majority of women were multiparous, but 13% were nulliparous. Overall, 45.3% of these unplanned out-of-hospital births were medically-driven, either by phone during medical regulation (12.5%) or on scene by the prehospital emergency medical service units (32.9%). The prevalence of neonatal morbidity and mortality was 6.3% (n = 106) after an unplanned out-of-hospital birth (death before Day 7: n = 20; 1.2%). The multivariate logistic regression found that multiparity (adjusted Odds Ratio = 70.7 [4.7–1062]), prematurity (adjusted Odds Ratio = 6.7 [2.1–21.4]), maternal pathology (adjusted Odds Ratio = 2.8 [1.0–7.5]) and hypothermia (adjusted Odds Ratio = 2.8 [1.1–7.6]) were independent predictive factors of neonatal morbidity and mortality.
Conclusions
Our study assessed for the first time risk factors for adverse perinatal outcome in a large and multicenter cohort of unplanned out-of-hospital births. We have to improve temperature management in the out-of-hospital field and future trials are required to investigate strategies to optimize newborns management in the prehospital area.
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Details
1 CHU Nantes, Nantes University Hospital, Department of Emergency Medicine, Nantes, France (GRID:grid.277151.7) (ISNI:0000 0004 0472 0371); MiHAR lab, Université de Nantes, Nantes, France (GRID:grid.4817.a)
2 Toulouse Purpan University Hospital, Emergency Department, Toulouse, France (GRID:grid.414282.9) (ISNI:0000 0004 0639 4960)
3 DRCI, CHU Nantes, Nantes, France (GRID:grid.277151.7) (ISNI:0000 0004 0472 0371)
4 Samu-21, CHU de Dijon, SAU-Smur, CH du Creusot, Dijon, France (GRID:grid.31151.37)
5 University Hospital of Angers, Emergency Department, SAMU 49, Angers, France (GRID:grid.411147.6) (ISNI:0000 0004 0472 0283)
6 CHU Nantes, Nantes University Hospital, Department of Emergency Medicine, Nantes, France (GRID:grid.277151.7) (ISNI:0000 0004 0472 0371)
7 Samu, groupement hospitalier Édouard-Herriot, Lyon, France (GRID:grid.277151.7)