Impact of regionalisation and case-volume on neonatal and perinatal mortality: an umbrella review
Objective This umbrella review summarises and critically appraises the evidence on the effects of regulated or high-volume perinatal care on outcome among very low birth weight/very preterm infants born in countries with neonatal mortality <5/1000 births.Intervention/exposition Perinatal regi...
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e037135.full |
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| author | Jochen Schmitt Stefanie Deckert Mario Rüdiger Felix Walther Denise Bianca Küster Anja Bieber Jürgen Malzahn |
| author_facet | Jochen Schmitt Stefanie Deckert Mario Rüdiger Felix Walther Denise Bianca Küster Anja Bieber Jürgen Malzahn |
| author_sort | Jochen Schmitt |
| collection | DOAJ |
| description | Objective This umbrella review summarises and critically appraises the evidence on the effects of regulated or high-volume perinatal care on outcome among very low birth weight/very preterm infants born in countries with neonatal mortality <5/1000 births.Intervention/exposition Perinatal regionalisation, centralisation, case-volume.Primary outcomes Death.Secondary outcomes Disability, discomfort, disease, dissatisfaction.Methods On 29 November 2019 a systematic search in MEDLINE and Embase was performed and supplemented by hand search. Relevant systematic reviews (SRs) were critically appraised with A MeaSurement Tool to Assess systematic Reviews 2.Results The literature search revealed 508 hits and three SRs were included. Effects of perinatal regionalisation were assessed in three (34 studies) and case-volume in one SR (6 studies). Centralisation has not been evaluated. The included SRs reported effects on ‘death’ (eg, neonatal), ‘disability’ (eg, mental status), ‘discomfort’ (eg, maternal sensitivity) and ‘disease’ (eg, intraventricular haemorrhages). ‘Dissatisfactions’ were not reported. The critical appraisal showed a heterogeneous quality ranging from moderate to critically low. A pooled effect estimate was reported once and showed a significant favour of perinatal regionalisation in terms of neonatal mortality (OR 1.60, 95% CI 1.33–1.92). The qualitative evidence synthesis of the two SRs without pooled estimate suggests superiority of perinatal regionalisation in terms of different mortality and non-mortality outcomes. In one SR, contradictory results of lower neonatal mortality rates were reported in hospitals with higher birth volumes.Conclusions Regionalised perinatal care seems to be a crucial care strategy to improve the survival of very low birth weight and preterm births. To overcome the low and critically low methodological quality and to consider additional clinical and patient-reported results that were not addressed by the SRs included, we recommend an updated SR. In the long term, an international, uniformly conceived and defined perinatal database could help to provide evidence-based recommendations on optimal strategies to regionalise perinatal care.PROSPERO registration number CRD42018094835. |
| format | Article |
| id | doaj-art-aa519554f05f4bdf9f5fd735f6075b97 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-aa519554f05f4bdf9f5fd735f6075b972025-01-08T20:40:15ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2020-037135Impact of regionalisation and case-volume on neonatal and perinatal mortality: an umbrella reviewJochen Schmitt0Stefanie Deckert1Mario Rüdiger2Felix Walther3Denise Bianca Küster4Anja Bieber5Jürgen Malzahn6Center for Evidence-based Healthcare, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, GermanyCenter for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany3 Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany3 Quality and Medical Risk Management, University Hospital Carl Gustav Carus Dresden, Dresden, GermanyCenter for Evidence-based Healthcare, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, GermanyInstitute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle, Saxony-Anhalt, GermanyClinical Care, Federation of Local Health Insurance Funds, Berlin, GermanyObjective This umbrella review summarises and critically appraises the evidence on the effects of regulated or high-volume perinatal care on outcome among very low birth weight/very preterm infants born in countries with neonatal mortality <5/1000 births.Intervention/exposition Perinatal regionalisation, centralisation, case-volume.Primary outcomes Death.Secondary outcomes Disability, discomfort, disease, dissatisfaction.Methods On 29 November 2019 a systematic search in MEDLINE and Embase was performed and supplemented by hand search. Relevant systematic reviews (SRs) were critically appraised with A MeaSurement Tool to Assess systematic Reviews 2.Results The literature search revealed 508 hits and three SRs were included. Effects of perinatal regionalisation were assessed in three (34 studies) and case-volume in one SR (6 studies). Centralisation has not been evaluated. The included SRs reported effects on ‘death’ (eg, neonatal), ‘disability’ (eg, mental status), ‘discomfort’ (eg, maternal sensitivity) and ‘disease’ (eg, intraventricular haemorrhages). ‘Dissatisfactions’ were not reported. The critical appraisal showed a heterogeneous quality ranging from moderate to critically low. A pooled effect estimate was reported once and showed a significant favour of perinatal regionalisation in terms of neonatal mortality (OR 1.60, 95% CI 1.33–1.92). The qualitative evidence synthesis of the two SRs without pooled estimate suggests superiority of perinatal regionalisation in terms of different mortality and non-mortality outcomes. In one SR, contradictory results of lower neonatal mortality rates were reported in hospitals with higher birth volumes.Conclusions Regionalised perinatal care seems to be a crucial care strategy to improve the survival of very low birth weight and preterm births. To overcome the low and critically low methodological quality and to consider additional clinical and patient-reported results that were not addressed by the SRs included, we recommend an updated SR. In the long term, an international, uniformly conceived and defined perinatal database could help to provide evidence-based recommendations on optimal strategies to regionalise perinatal care.PROSPERO registration number CRD42018094835.https://bmjopen.bmj.com/content/10/9/e037135.full |
| spellingShingle | Jochen Schmitt Stefanie Deckert Mario Rüdiger Felix Walther Denise Bianca Küster Anja Bieber Jürgen Malzahn Impact of regionalisation and case-volume on neonatal and perinatal mortality: an umbrella review BMJ Open |
| title | Impact of regionalisation and case-volume on neonatal and perinatal mortality: an umbrella review |
| title_full | Impact of regionalisation and case-volume on neonatal and perinatal mortality: an umbrella review |
| title_fullStr | Impact of regionalisation and case-volume on neonatal and perinatal mortality: an umbrella review |
| title_full_unstemmed | Impact of regionalisation and case-volume on neonatal and perinatal mortality: an umbrella review |
| title_short | Impact of regionalisation and case-volume on neonatal and perinatal mortality: an umbrella review |
| title_sort | impact of regionalisation and case volume on neonatal and perinatal mortality an umbrella review |
| url | https://bmjopen.bmj.com/content/10/9/e037135.full |
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