日本新生児成育医学会雑誌　第29巻　第1号　117～125頁（2017年）

日本新生児成育医学会雑誌　29(1)：117-125；2017　

受付日：平成28．05．30

受理日：平成28．09．12

当院周産期センターNICU における27 年間の診療実績の総括
―神奈川県周産期医療の地域化（Regionalization）の変遷に照らした考察―

Summary of Outcomes Over 27 Years at Our Perinatal Center Neonatal Intensive Care Unit
—Discussion in Light of the Transition to Regionalization of the Perinatal Emergency Medical Care System of Kanagawa Prefecture—

＊1聖マリアンナ医科大学横浜市西部病院　周産期センター　新生児部門
＊2聖マリアンナ医科大学　小児科学教室

＊ 1 Department of Neonatology, St. Marianna University School of Medicine Yokohama City Seibu Hospital
＊ 2 Department of Pediatrics, St. Marianna University School of Medicine

正木　宏＊1・堀内　勁＊2・笹本優佳＊1・丸山和哉＊1・鈴木真波＊1

Hiroshi MASAKI＊1，Takeshi HORIUCHI＊2，Yuka SASAMOTO＊1，Kazuya MARUYAMA＊1，Manami SUZUKI＊1

Key Words：regionalization，late preterm infant（ LPI），very low birth weight（ VLBW） infant，extremely low birth weight（ ELBW） infant

　当院周産期センターNICU の開設から27年間の診療実績を3期（前，中，後期）に分け検証した。開設時は，神奈川県の周産期医療が地域化（regionalization）に取り組み始めた時期と重なった。入院数は中期にかけて減少し，その後は概ね均衡化した。入院内訳は，後期にかけて院外出生が減少，在胎30週未満の早産が減少，late preterm infant（LPI）が増加した。死亡退院は，後期にかけて漸減し，院外出生死亡率が前期に比し後期で低下した。在胎24週未満および出生体重500g未満の死亡率は後期で低下せず，より未熟な早産児の救命に課題が残った。当院NICUの診療実績は，神奈川県周産期医療の地域化の発展と共に変化し向上した可能性がある。今後は，LPI母子への対応と未熟出生児の救命率向上について周産期医療の地域連動性という視点に立って取り組むことが課題と考えた。

　We evaluated the outcomes obtained at our perinatal center neonatal intensive care unit（ NICU） since its inception 27 years ago. We divided this duration into three periods（ early, middle, and late）. The opening of the NICU coincided with the beginning of the initiative for the transition to regionalization of the perinatal emergency medical care system of Kanagawa Prefecture. The number of hospitalizations decreased toward the middle period, after which the trend stabilized. Of the hospitalizations, the number of out-of-hospital and preterm births before 30 weeks of gestation decreased during the late period, whereas the number of late preterm infants（ LPIs） increased. Hospital mortalities gradually decreased during the late period, and the rate of out-of-hospital birth mortalities decreased during the late period compared with that during the early period. Mortality rates for infants born before 24 weeks of gestation or weighing less than 500g did not decrease during the late period, indicating that life-saving care for premature infants remained challenging. The outcomes in our NICU exhibited improvements and changes in accordance with the transition to regionalization of the perinatal emergency medical care system of Kanagawa Prefecture. Improving life-saving rates for premature infants and caring for LPIs and their mothers must be considered in the future.