Background
Methods
Data sources
Definition of the study population
Analysis
Study goals
Neonatal endpoints
Statistical methods
Results
Completeness and accuracy of the data
1) Comparison between MCD* and NIS°: number and distribution of live born infants, according to residence | ||||
---|---|---|---|---|
2002 | 2004 | |||
Residence | MCD | NIS | MCD | NIS |
Belgium | (N = 111,609) | (N = 111,225) | (N = 116,142) | (N = 115,618) |
Flanders | 53.1 | 53.7 | 53.0 | 53.9 |
Wallonia | 33.2 | 33.8 | 32.4 | 32.9 |
Brussels | 13.1 | 12.5 | 13.8 | 13.1 |
Abroad | 0.6 | - | 0.8 | - |
2) Comparison between MCD and SPE
+
: perinatal characteristics
| ||||
2002
|
2004
| |||
Deliveries
|
MCD
|
NIS
|
MCD
|
NIS
|
(N = 58,194) | (N = 58,841) | (N = 59,126) | (N = 61,647) | |
Multiple gestation | ||||
twins | 2.3 | 2.0 | 2.0 | 1.6 |
triplets | 0.1 | 0.0 | 0.1 | 0.0 |
Hypertension | 5.5 | 4.9 | 5.8 | 4.8 |
Diabetes | 1.6 | 1.2 | 2.1 | 1.4 |
Gestational age | ||||
20–31 weeks | 1.0 | 1.0 | 1.1 | 1.1 |
32–36 weeks | 6.1 | 6.3 | 6.4 | 6.5 |
>= 37 weeks | 92.9 | 92.7 | 92.8 | 92.5 |
Labor induction | 19.4 | 30.1 | 17.7 | 27.6 |
Epidural anesthesia | 48.3 | 63.2 | 51.3 | 61.6 |
Cesarean delivery | 18.1 | 17.7 | 18.5 | 18.3 |
Previous cesarean | 4.6 | 7.6 | 5.7 | 8.2 |
Births
|
MCD
|
NIS
|
MCD
|
NIS
|
(N = 58,529) | (N = 60,048) | (N = 59,110) | (N = 62,657) | |
Presentation | ||||
breech | 4.5 | 5.4 | 4.5 | 5.2 |
transverse | 0.5 | 0.6 | 0.4 | 0.5 |
Type of birth | ||||
spontaneous | 72.5 | 69.9 | 71.3 | 70.2 |
vacuum | 8.5 | 10.3 | 9.1 | 9.7 |
forceps | 0.6 | 1.1 | 0.5 | 0.9 |
cesarean | 17.9 | 18.3 | 18.2 | 18.9 |
vaginal breech | 0.5 | 0.4 | 0.4 | 0.3 |
Weight at birth | ||||
<1500 g | 0.8 | 1.2 | 0.8 | 1.1 |
1500–2499 g | 5.6 | 6.2 | 5.4 | 5.8 |
>= 2500 g | 93.3 | 92.7 | 93.7 | 93.1 |
Gender | ||||
male | 51.4 | 51.4 | 51.4 | 51.4 |
female | 48.6 | 48.6 | 48.6 | 48.6 |
Congenital anomalies | 3.0 | 1.8 | 3.1 | 1.6 |
Admission into specialized unit | 17.9 | 17.9 | 17.9 | 17.8 |
Low risk pregnancies
Characteristics of the study population and mode of delivery. Belgium 2001–2004
CS | % | Total | CS | % | Total | ||
---|---|---|---|---|---|---|---|
1) Maternal | 2) Neonatal | ||||||
Age classes
|
Gender
| ||||||
< 20 years | 765 | 9.40 | 8,140 | Boys | 26,862 | 13.69 | 196,191 |
20–24 years | 5,910 | 10.37 | 57,010 | Girls | 22,713 | 12.23 | 185,755 |
25–29 years | 15,987 | 11.92 | 134,071 | Undetermined | 3 | 23 | |
30–34 years | 17,342 | 13.75 | 126,098 |
Birth weight
| |||
35–39 years | 7,746 | 16.27 | 47,613 | 2500–2999 g | 9,444 | 13.78 | 68,511 |
40 years+ | 1,828 | 20.18 | 9,057 | 3000–3499 g | 20,431 | 12.18 | 167,699 |
Admission Day
| 3500–3999 g | 15,119 | 12.89 | 117,250 | |||
Monday | 9,560 | 14.84 | 64,422 | 4000–4499 g | 4,584 | 16.07 | 28,529 |
Tuesday | 8,827 | 13.80 | 63,948 |
Gestational age group
| |||
Wednesday | 8,780 | 14.22 | 61,762 | 37–38 weeks | 18,531 | 18.77 | 98,712 |
Thursday | 8,961 | 14.29 | 62,729 | 39–40 weeks | 25,628 | 10.56 | 242,645 |
Friday | 5,212 | 10.73 | 48,555 | 41–42 weeks | 5,419 | 13.34 | 40,632 |
Saturday | 2,441 | 7.21 | 33,836 |
1 min Apgar
| |||
Sunday | 5,797 | 12.40 | 46,737 | Missing | 10 | 16.13 | 62 |
Semester
| < 4 | 1,141 | 21.61 | 5,281 | |||
2001-1 | 5,672 | 11.99 | 47,287 | 4 – 6 | 2,857 | 14.65 | 19,507 |
2001-2 | 5,975 | 12.43 | 48,058 | > 6 | 45,570 | 12.76 | 357,139 |
2002-1 | 5,757 | 12.51 | 46,023 |
5 min Apgar
| |||
2002-2 | 6,254 | 13.14 | 47,605 | Missing | 10 | 15.38 | 65 |
2003-1 | 6,161 | 13.27 | 46,421 | < 4 | 163 | 21.73 | 750 |
2003-2 | 6,550 | 13.55 | 48,356 | 4 – 6 | 703 | 18.03 | 3,898 |
2004-1 | 6,319 | 13.24 | 47,734 | > 6 | 48,702 | 12.91 | 377,276 |
2004-2 | 6,890 | 13.64 | 50,505 |
Respiratory Syndromes
| |||
RDS | 480 | 31.27 | 1,535 | ||||
Wet lung | 552 | 32.43 | 1,702 | ||||
Meconium Aspiration | 510 | 19.23 | 2,652 | ||||
Intubation/Ventilation
| 959 | 27.88 | 3,440 | ||||
Congenital Anomaly
| 559 | 16.57 | 3,374 | ||||
Admission N*/NICU
| 9,850 | 15.31 | 64,326 |
Inter-hospital differences in CSR
ID1
| Period | Trend | IP10
| ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
LB_B2
| LB_953
|
D(%)
4
| UB_955
| UB_B6
| CI_957
| CI_B8
| P9
| LB_B2
| LB_953
|
D(%)
4
| UB_955
| UB_B6
| CI_957
| CI_B8
| P9
| ||
1
| -18 | -10 | 3 | 16 | 28 | NS | NS | 0.68283 | -11 | -7 |
-2
| 4 | 8 | NS | NS | 0.51065 | GM |
2
| 24 | 33 | 44 | 56 | 66 | + | + | <0.00001 | -8 | -5 |
-1
| 3 | 6 | NS | NS | 0.57928 |
EA
|
3
| -20 | -10 | 5 | 23 | 38 | NS | NS | 0.49978 | -16 | -11 |
-5
| 2 | 8 | NS | NS | 0.18024 |
GM
|
4
| 9 | 18 | 31 | 44 | 56 | + | + | <0.00001 | -8 | -4 |
0
| 5 | 9 | NS | NS | 0.90712 |
GM
|
5
| -20 | -11 | 1 | 15 | 27 | NS | NS | 0.88383 | -10 | -6 |
0
| 5 | 10 | NS | NS | 0.93539 |
GM
|
6
| 9 | 14 | 21 | 29 | 35 | + | + | <0.00001 | 0 | 2 |
5
| 8 | 10 | + | NS | 0.00045 |
GM
|
7
| 0 | 7 | 16 | 26 | 35 | + | NS | 0.00061 | -9 | -7 |
-3
| 1 | 4 | NS | NS | 0.11081 |
GM
|
8
| -32 | -26 | -19 | -11 | -5 | - | - | <0.00001 | -10 | -7 |
-3
| 1 | 4 | NS | NS | 0.10727 |
GM
|
9
| -12 | -7 | 1 | 10 | 17 | NS | NS | 0.75745 | -2 | 1 |
4
| 8 | 11 | + | NS | 0.01709 |
GM
|
10
| -45 | -40 | -33 | -26 | -19 | - | - | <0.00001 | -7 | -3 |
1
| 6 | 9 | NS | NS | 0.67442 |
EA
|
National CSR and its determinants
OR | P | |
---|---|---|
a) National trend adjusted for age group | ||
Semestrial trend (basis 1st semester 2001) | 1.02 (1.02; 1.02) | <0.01 |
Age group
| ||
20–24 years vs < 20 years | 1.11 (1.11; 1.11) | <0.01 |
25–29 years vs < 20 years | 1.30 (1.30; 1.30) | <0.01 |
30–34 years vs < 20 years | 1.53 (1.53; 1.53) | <0.01 |
35–39 years vs < 20 years | 1.86 (1.86; 1.86) | <0.01 |
40 years+ vs < 20 years | 2.41 (2.41; 2.41) | <0.01 |
b) National trend of CSR and determinants
| ||
Semestrial trend (basis 1st semester 2001) | 1.02 (1.01; 1.02) | <0.01 |
Age group
| ||
20–24 years vs < 20 years | 1.12 (1.09; 1.22) | 0.02 |
25–29 years vs < 20 years | 1.31 (1.20; 1.43) | <0.01 |
30–34 years vs < 20 years | 1.55 (1.42; 1.69) | <0.01 |
35–39 years vs < 20 years | 1.89 (1.73; 2.07) | <0.01 |
40 years+ vs < 20 years | 2.45 (2.21; 2.71) | <0.01 |
Gestational age
| ||
37–38 weeks vs 39–40 weeks | 1.93 (1.87; 2.00) | <0.01 |
41–42 weeks vs 39–40 weeks | 1.31 (1.26; 1.36) | <0.01 |
Residence
| ||
Antwerp vs National | 1.00 (0.94; 1.05) | 0.73 |
Brussels vs National | 0.89 (0.84; 0.94) | <0.01 |
Brabant (F) vs National | 0.97 (0.91; 1.05) | 0.29 |
Brabant (W) vs National | 0.82 (0.75; 0.89) | <0.01 |
West Flanders vs National | 1.10 (1.02; 1.18) | 0.01 |
East Flanders vs National | 1.06 (1.00; 1.13) | <0.01 |
Hainaut vs National | 0.94 (0.88; 1.00) | <0.01 |
Liège vs National | 1.34 (1.25; 1.44) | <0.01 |
Limburg vs National | 1.24 (1.14; 1.34) | <0.01 |
Luxembourg vs National | 1.01 (0.86; 1.18) | 0.92 |
Namur vs National | 0.83 (0.77; 0.90) | <0.01 |
Abroad vs National | 0.93 (0.79; 1.09) | 0.20 |
Admission day
| ||
Monday vs Sunday | 1.22 (1.15; 1.29) | <0.01 |
Tuesday vs Sunday | 1.13 (1.06; 1.19) | <0.01 |
Wednesday vs Sunday | 1.17 (1.10; 1.23) | <0.01 |
Thursday vs Sunday | 1.17 (1.11; 1.24) | <0.01 |
Friday vs Sunday | 0.85 (0.80; 0.90) | <0.01 |
Saturday vs Sunday | 0.55 (0.52; 0.59) | <0.01 |
Neonatal outcomes
CSR groups | |||||||||
---|---|---|---|---|---|---|---|---|---|
High | (%) | Average | (%) | Low | (%) | Total | P | ||
1 min Apgar
|
Vaginal
| ||||||||
< 4 | 299 | 1.05 | 3,169 | 1.22 | 672 | 1.52 | 4,140 | <0.01 | |
4 – 6 | 1,512 | 5.31 | 12,857 | 4.95 | 2,281 | 5.16 | 16,650 | ||
>6 | 26,680 | 93.64 | 243,671 | 93.83 | 41,218 | 93.31 | 311,569 | ||
CS
| |||||||||
< 4 | 96 | 1.41 | 918 | 2.38 | 127 | 2.98 | 1,141 | <0.01 | |
4 – 6 | 349 | 5.14 | 2,223 | 5.77 | 285 | 6.68 | 2,857 | ||
>6 | 6,351 | 93.45 | 35,366 | 91.84 | 3,853 | 90.34 | 45,570 | ||
5 min Apgar
|
Vaginal
| ||||||||
< 4 | 32 | 0.11 | 478 | 0.18 | 77 | 0.17 | 587 | <0.01 | |
4 – 6 | 180 | 0.63 | 2,533 | 0.98 | 482 | 1.09 | 3195 | ||
>6 | 28,279 | 99.26 | 256,686 | 98.84 | 43,609 | 98.73 | 328,574 | ||
CS
| |||||||||
< 4 | 11 | 0.16 | 135 | 0.35 | 17 | 0.40 | 163 | <0.01 | |
4 – 6 | 51 | 0.75 | 564 | 1.46 | 88 | 2.06 | 703 | ||
>6 | 6,734 | 99.09 | 37,808 | 98.18 | 4,160 | 97.54 | 48,702 | ||
RDS
|
Vaginal
| ||||||||
Absent | 28,405 | 99.68 | 258,913 | 99.69 | 44,038 | 99.66 | 331,356 | 0.73 | |
Present | 90 | 0.32 | 816 | 0.31 | 149 | 0.34 | 1,055 | ||
CS
| |||||||||
Absent | 6,718 | 98.84 | 38,174 | 99.12 | 4,206 | 98.57 | 49,098 | <0.01 | |
Present | 79 | 1.16 | 340 | 0.88 | 61 | 1.43 | 480 | ||
MAS
|
Vaginal
| ||||||||
Absent | 28,331 | 99.42 | 257,974 | 99.32 | 43,964 | 99.50 | 330,269 | <0.01 | |
Present | 164 | 0.58 | 1,755 | 0.68 | 223 | 0.50 | 2,142 | ||
CS
| |||||||||
Absent | 6,744 | 99.22 | 38,116 | 98.97 | 4,208 | 98.62 | 49,068 | <0.01 | |
Present | 53 | 0.78 | 398 | 1.03 | 59 | 1.38 | 510 | ||
TTN
|
Vaginal
| ||||||||
Absent | 28,425 | 99.75 | 258,814 | 99.65 | 44,022 | 99.63 | 331,261 | <0.01 | |
Present | 70 | 0.25 | 915 | 0.35 | 165 | 0.37 | 1,150 | ||
CS
| |||||||||
Absent | 6,740 | 99.16 | 38,082 | 98.88 | 4,204 | 98.52 | 49,026 | <0.01 | |
Present | 57 | 0.84 | 432 | 1.12 | 63 | 1.48 | 552 | ||
Intubation/Ventilation
|
Vaginal
| ||||||||
Absent | 28,295 | 99.30 | 257,854 | 99.28 | 43,781 | 99.08 | 329,930 | <0.01 | |
Present | 200 | 0.70 | 1,875 | 0.72 | 406 | 0.92 | 2,481 | ||
CS
| |||||||||
Absent | 6,670 | 98.13 | 37,804 | 98.16 | 4,145 | 97.14 | 48,619 | <0.01 | |
Present | 127 | 1.87 | 710 | 1.84 | 122 | 2.86 | 959 | ||
Admission to specialized neonatal service
|
Vaginal
| ||||||||
Absent | 27,818 | 97.62 | 212,951 | 81.99 | 37,166 | 84.11 | 277,935 | <0.01 | |
Present | 677 | 2.38 | 46,778 | 18.01 | 7,021 | 15.89 | 54,476 | ||
CS
| |||||||||
Absent | 6,459 | 95.03 | 29,950 | 77.76 | 3,319 | 77.78 | 39,728 | <0.01 | |
Present | 338 | 4.97 | 8,564 | 22.24 | 948 | 22.22 | 9,850 |
Response Variable | OR | P | |
---|---|---|---|
a) 1 minute Apgar | |||
Male vs Female | Apgar 0–3 | 1.32 (1.25; 1.40) | <0.01 |
Apgar 4–6 | 1.22 (1.19; 1.26) | <0.01 | |
CS vs VD | Apgar 0–3 | 1.76 (1.59; 1.95) | <0.01 |
Apgar 4–6 | 1.17 (1.10; 1.24) | <0.01 | |
CSR group: High vs Low | Apgar 0–3 | 0.56 (0.48; 0.65) | <0.01 |
Apgar 4–6 | 0.87 (0.80; 0.95) | <0.01 | |
CSR group: High vs Average | Apgar 0–3 | 0.71 (0.48; 0.80) | <0.01 |
Apgar 4–6 | 0.97 (0.91; 1.03) | 0.33 | |
CSR group: Low vs Average | Apgar 0–3 | 1.27 (1.14; 1.40) | <0.01 |
Apgar 4–6 | 1.12 (1.04; 1.19) | <0.01 | |
Average and CS vs High and VD | Apgar 0–3 | 1.22 (1.08; 1.37) | 0.02 |
Apgar 4–6 | 1.11 (1.04; 1.18) | <0.01 | |
Average and CS vs Low and VD | Apgar 0–3 | 0.99 (0.90; 1.10) | 0.88 |
Apgar 4–6 | 0.94 (0.88; 1.01) | 0.08 | |
High and CS vs Low and VD | Apgar 0–3 | 0.82 (0.70; 0.95) | 0.02 |
Apgar 4–6 | 0.85 (0.78; 0.93) | <0.01 | |
b) 5 minute Apgar
| |||
Male vs Female | Apgar 0–3 | 1.29 (1.12; 1.49) | <0.01 |
Apgar 4–6 | 1.31 (1.23; 1.40) | <0.01 | |
CS vs VD | Apgar 0–3 | 1.84 (1.37; 2.47) | <0.01 |
Apgar 4–6 | 1.52 (1.33; 1.74) | <0.01 | |
CSR group: High vs Low | Apgar 0–3 | 0.51 (0.33; 0.79) | <0.01 |
Apgar 4–6 | 0.45 (0.37; 0.55) | <0.01 | |
CSR group: High vs Average | Apgar 0–3 | 0.53 (0.37; 0.76) | <0.01 |
Apgar 4–6 | 0.57 (0.49; 0.68) | <0.01 | |
CSR group: Low vs Average | Apgar 0–3 | 1.04 (0.79; 1.38) | 0.78 |
Apgar 4–6 | 1.27 (1.12; 1.43) | <0.01 | |
Average and CS vs High and VD | Apgar 0–3 | 1.15 (0.80; 1.64) | 0.45 |
Apgar 4–6 | 1.13 (0.96; 1.33) | 0.15 | |
Average and CS vs Low and VD | Apgar 0–3 | 0.91 (0.69; 1.21) | 0.51 |
Apgar 4–6 | 0.89 (0.78; 1.00) | 0.06 | |
High and CS vs Low and VD | Apgar 0–3 | 0.79 (0.51; 1.22) | 0.29 |
Apgar 4–6 | 0.79 (0.65; 0.96) | 0.02 |