RESUMO
OBJECTIVE: To assess antenatal and intrapartum risk factors for seizures occurring during the birth admission. STUDY DESIGN: Using multivariable logistic regression analysis, we evaluated the association between maternal characteristics and birth admission seizures in a cohort of 2.3 million California children born at >or=36 weeks' gestation between 1998 and 2002 using the California Office of Statewide Planning and Development database containing birth certificates linked to infant and maternal hospital discharge abstracts. RESULTS: The incidence of seizures during the birth admission was 0.95/1000 live births. In an adjusted analysis, infants of women age 40 years and older who were nulliparous; had diabetes mellitus, intrapartum fever, or infection or delivered at >or=42 weeks had an increased risk of seizures. Infants of Hispanic and Asian mothers had a lower risk compared with infants of Caucasian mothers. CONCLUSIONS: Several maternal antenatal and intrapartum factors increased the risk of seizures during the birth admission. Identifying and avoiding risks for neonatal seizures may lead to lower infant neurologic morbidity and mortality.
Assuntos
Convulsões/epidemiologia , California/epidemiologia , Corioamnionite/epidemiologia , Feminino , Humanos , Incidência , Recém-Nascido , Idade Materna , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Gravidez em Diabéticas/epidemiologia , Fatores de Risco , Convulsões/etnologiaRESUMO
OBJECTIVE: The California Perinatal Quality Care Collaborative (CPQCC) was formed to seek perinatal care improvements by creating a confidential multi-institutional database to identify topics for quality improvement (QI). We aimed to evaluate this approach by assessing antenatal steroid administration before preterm (24 to 33 weeks of gestation) delivery. We hypothesized that mean performance would improve and the number of centers performing below the lowest quartile of the baseline year would decrease. STUDY DESIGN: In 1998, a statewide QI cycle targeting antenatal steroid use was announced, calling for the evaluation of the 1998 baseline data, dissemination of recommended interventions using member-developed educational materials, and presentations to California neonatologists in 1999-2000. Postintervention data were assessed for the year 2001 and publicly released in 2003. A total of 25 centers voluntarily participated in the intervention. RESULTS: Antenatal steroid administration rate increased from 76% of 1524 infants in 1998 to 86% of 1475 infants in 2001 (P < .001). In 2001, 23 of 25 hospitals exceeded the 1998 lower-quartile cutoff point of 69.3%. CONCLUSIONS: Regional collaborations represent an effective strategy for improving the quality of perinatal care.