极低和超低出生体重儿生存随访和放弃治疗院内因素分析

目的：总结2000~2008年该院新生儿重症监护室（NICU）住院的极低和超低出生体重儿的生存情况,分析放弃治疗的院内因素。方法：采用回顾性病例对照研究方法,收集148例患儿的临床资料并随访。通过单因素检验和logistic回归对放弃治疗患儿的危险因素进行分析。结果：148例患儿中,院内死亡20例（13.5%）,出院后死亡3例（2.0%）,放弃治疗后死亡19例（12.8%）,出院后失访30例（20.3%）,随访存活病例76例（51.4%）。存活病例中正常47例,先天遗传病2例,不良预后27例。多因素logistic回归分析表明,放弃治疗的院内高危因素主要是新生儿呼吸窘迫综合征（RDS）（P=0.030,OR=11.396,95%CI 1.264~102.701）和住院年限为2004~2006年（P=0.039,OR=9.869,95%CI 1.118~87.140）。结论：极低和超低出生体重儿生存情况不容乐观;减少新生儿RDS的发生率可能有利于减少院内放弃治疗病例。     

NICU新生儿院内感染情况及危险因素分析

目的：通过分析该院新生儿重症监护室(NICU)2012年1月至2013年10月新生儿院内感染的发生情况,探讨院内感染发生的危险因素。方法回顾性分析NICU住院时间超过48 h新生儿的临床资料,分析院内感染发生、发展及相关的危险因素。结果该研究中1357例患儿发生院内感染202例次,院内感染发生率为14．89%(202/1375),日感染率为10．44‰(202/19355)。不同出生体重与胎龄患儿院内感染发生率比较有统计学意义,其中出生体重<1000 g患儿院感发生率为75．00%,胎龄<30周患儿院内感染发生率为52．63%。最常见的院内感染类型是肺炎[43．07%(87/202)]与败血症[26．73%(54/202)]。院内感染患儿比非院内感染患儿住院时间长(中位住院时间：20 d与10 d)(P<0．01),住院费用高(中位住院费用：21045．32元与8108．23元)(P<0．01)。单因素分析结果显示,院内感染患儿与非院内感染患儿在胎龄、出生体重、5 min Apgar评分、窒息抢救史、感染前抗生素使用、机械通气、中心静脉置管、胸腔闭式引流管、感染前胸腹部手术方面比较差异有显著统计学意义,Logistic 回归分析显示,机械通气、中心静脉置管及感染前使用抗生素为院内感染的独立危险因素。结论 NICU新生儿院内感染发生率比较高,机械通气、中心静脉置管及感染前使用抗生素为NICU院内感染独立危险因素。     

超未成熟儿的生存状况与预后影响因素分析

目的 探讨胎龄28 周以下超未成熟儿在新生儿重症监护病房（NICU）的存活率、住院期间并发症发生情况及其预后。方法 收集2011 年1 月至2013 年3 月入住NICU 的胎龄结果 90 例患儿平均胎龄26±1 周,出生体重898±165 g,总存活率为57%,病死率9%,放弃率34%。常见并发症包括新生儿呼吸窘迫综合征（RDS）88%、BPD 85%、PDA 69%, ROP 68%,Ⅲ、Ⅳ级IVH 31%;存活早产儿平均住院时间为83±18 d,出院平均体重为2419±300 g。多因素logistic 回归分析发现,肺出血与严重IVH 为死亡或放弃的高危因素,产前使用糖皮质激素为保护因素。结论 目前国内超未成熟儿存活率相比发达国家仍有较大差距;肺出血、严重IVH 为影响预后的重要因素。     

新生儿高胆红素血症再入院的现状和危险因素分析

目的 探讨新生儿高胆红素血症再入院情况及相关危险因素。方法 选择2017年1月至2019年12月新生儿高胆红素血症再入院患儿85例作为研究组,按1：2比例在同期新生儿高胆红素血症未再入院病例中配对随机选取170例作为对照组,分析比较两组患儿的临床资料及再入院的危险因素。结果 研究期间新生儿高胆红素血症再入院率为2.30%,中位再入院间隔天数为5 d。研究组首次出院时总胆红素和间接胆红素水平明显高于对照组（P < 0.05）;首次住院期间蓝光治疗时间长于对照组（P < 0.05）。研究组出生体重、胎龄、首次入院时年龄均低于对照组（P < 0.05）,研究组合并葡萄糖-6-磷酸脱氢酶（G-6-PD）缺乏症比例和合并溶血病比例高于对照组（P < 0.05）。多因素logsitic分析显示,胎龄小、首次入院时年龄小、合并G-6-PD缺乏症是新生儿高胆红素血症再入院的危险因素（分别OR=1.792、1.415、2.829,P < 0.05）。结论 对存在胎龄小、首次入院时年龄小、合并G-6-PD缺乏症等高危因素的高胆红素血症新生儿,应加强住院及出院后管理,防止该病再入院的发生。     

新生儿高胆红素血症再入院的现状和危险因素分析

目的 探讨新生儿高胆红素血症再入院情况及相关危险因素。方法 选择2017年1月至2019年12月新生儿高胆红素血症再入院患儿85例作为研究组,按1：2比例在同期新生儿高胆红素血症未再入院病例中配对随机选取170例作为对照组,分析比较两组患儿的临床资料及再入院的危险因素。结果 研究期间新生儿高胆红素血症再入院率为2.30%,中位再入院间隔天数为5 d。研究组首次出院时总胆红素和间接胆红素水平明显高于对照组（P < 0.05）;首次住院期间蓝光治疗时间长于对照组（P < 0.05）。研究组出生体重、胎龄、首次入院时年龄均低于对照组（P < 0.05）,研究组合并葡萄糖-6-磷酸脱氢酶（G-6-PD）缺乏症比例和合并溶血病比例高于对照组（P < 0.05）。多因素logsitic分析显示,胎龄小、首次入院时年龄小、合并G-6-PD缺乏症是新生儿高胆红素血症再入院的危险因素（分别OR=1.792、1.415、2.829,P < 0.05）。结论 对存在胎龄小、首次入院时年龄小、合并G-6-PD缺乏症等高危因素的高胆红素血症新生儿,应加强住院及出院后管理,防止该病再入院的发生。     

新生儿发生产肺炎克雷伯碳青霉烯酶的肺炎克雷伯菌定植的危险因素分析

目的 探讨新生儿重症监护室（NICU）新生儿发生产肺炎克雷伯碳青霉烯酶的肺炎克雷伯菌（KPC-Kp）定植的危险因素。方法 采用病例对照研究方法,病例组为NICU 住院新生儿中有KPC-Kp 定植的新生儿9 例,随机选取同期NICU 无该菌定植的新生儿18 例作为对照组。对两组行单因素及logistic 多因素回归分析了解定植KPC-Kp 的危险因素。结果 单因素分析显示有统计学意义的因素有：出生胎龄、出生体重、住院天数、呼吸机使用时间、先天性心脏病、经外周静脉穿刺中心静脉插管、外科手术、静脉营养时间、使用碳青霉烯类抗生素及使用时间、使用糖肽类抗生素。Logistic 多因素回归分析显示碳青霉烯类抗生素使用时间（>4 d）是NICU 新生儿定植KPC-Kp 的独立危险因素（OR=18.7,95%CI：1.98~175.5,P=0.01）。控制该菌定植方法包括对定植KPC-Kp 新生儿的隔离、监测以及抗生素的合理使用。结论 较长时间使用碳青霉烯类抗生素是NICU新生儿发生KPC-Kp 定植的独立危险因素。     

新生儿毛细血管渗漏综合征的高危因素分析

目的：探讨毛细血管渗漏综合征（CLS）发生的危险因素。方法：回顾性分析52例发生CLS患儿（病例组）的临床资料,另选取50例未发生CLS的住院新生儿作为对照组。对CLS发生的因素进行单因素分析,应用多元logistic 回归分析确定与 CLS 相关的独立危险因素。结果：单因素分析显示病例组高血糖、败血症、呼吸窘迫综合征（RDS）、寒冷损伤综合征的发生比率显著高于对照组,差异有统计学意义（P<0.05）。经多元logistic回归分析显示,败血症(OR=5.004,P=0.001)、RDS(OR=3.880,P=0.013)、寒冷损伤综合征(OR=3.207,P=0.023)是发生CLS的独立危险因素。结论：败血症、RDS、寒冷损伤综合征是CLS发生的独立危险因素;高血糖可能与CLS的发生有关。     

新生儿出院准备度与不良健康事件的关系

目的 探讨新生儿出院准备度与发生不良健康事件的关系。方法 选取甘肃省3个不同级别医院出生的新生儿及父母为研究对象,调查新生儿父母的出院准备度,将出院准备度分为低、中、高水平3组;随访新生儿出院后1个月内不良健康事件的发生情况,分析新生儿出院准备度与不良健康事件的关系。结果 发生不良健康事件的新生儿出院准备度低于未发生不良健康事件的新生儿(P<0.05)。多因素logistic回归分析显示,出院准备度中水平组和高水平组的新生儿不良健康事件发生率较低水平组分别减少了34.8%和78.7%(P<0.05)。新生儿再入院率为8.1%(35/430),因病再入院的新生儿出院准备度低于未因病再入院的新生儿(P<0.05)。多因素logistic回归分析显示,出院准备度中水平组和高水平组的新生儿再入院率较低水平组分别减少了67.4%和84.2%(P<0.05)。结论 出院准备度会影响新生儿出院后1个月内不良健康事件的发生率和再入院率。医护人员应开展有效的干预措施来提高新生儿出院准备度,以降低不良健康事件的发生率和再入院率。[中国当代儿科杂志,2022,24 (9):1001-...     

一所地市级医院NICU中新生儿肺出血的高危因素分析

目的探讨某地市级医院NICU中发生新生儿肺出血(NPH)高危因素,为地市级医院救治NPH提供早期识别依据。方法某地市级医院NICU确诊的112例NPH患儿作为病例组,按巢式病例配对法选取同期住院、予呼吸机辅助呼吸但未并发生肺出血的224例新生儿为对照组,采用单因素分析和非条件logistic回归分析法对NPH的高危因素进行统计学分析。结果单因素分析结果显示:病例组母妊娠期糖尿病及胆汁淤积症,患儿剖腹产出生,胎龄34周,5 min Apgar评分≤5分,体重2 500 g,NPH前出现心力衰竭、弥漫性血管内凝血(DIC)、PaO_2/FiO_2(氧合指数,OI)≤100及平均血小板体积减小的发生比率明显高于对照组。Logistic回归多因素分析显示:DIC、心力衰竭、OI≤100是NPH的独立危险因素(OR分别为33.975、3.975、1.818;P0.05)。结论心力衰竭、OI≤100、DIC是地市级医院NICU发生NPH高危因素,应针对这些因素开展积极的原发病治疗和病情监测。     

胆道闭锁儿童肝移植术后90天再入院危险因素分析

目的 调查胆道闭锁儿童在肝移植术后90天再入院率及危险因素。方法 回顾性分析上海交通大学医学院附属新华医院、仁济医院和上海儿童医学中心确诊为胆道闭锁，2019年1月1日至2019年12月31日首次接受肝移植手术治疗患儿的临床资料。比较再入院组和未再入院组间临床特征，分析再入院的危险因素。结果 共纳入264例患儿，男124例、女140例，中位年龄6.9(5.6～9.4)月。儿童肝移植术后90天再入院率为22.0%(58/264)。与未再入院组相比，再入院组患儿PELD评分、血清总胆汁酸水平、INR较高，住院时间较长，血小板计数、腰肌面积较低，差异均有统计学意义（P<0.05）。二元logistic回归分析示血小板减少症(OR=2.347,95%CI:1.154～4.776)、血清总胆汁酸水平(OR=1.058,95%CI:1.011～1.106)、腰肌面积(OR=0.615,95%CI:0.301～0.989)、住院时间(OR=1.069,95%CI:1.031～1.109)是肝移植术后再入院的影响因素（P均<0.05）。结论 血小板减少症、血清总胆汁酸水平升高、腰肌面积减少...     

Incidence of and predictors for short‐term readmission among preterm low‐birthweight infants

Background: Readmission temporally close to discharge can best reflect the quality of care received in the last hospitalization, and has been considered a valuable indicator for the quality of care received. The aim of the present study was to investigate the incidence of and predictors for readmission within 31 days after discharge among preterm low‐birthweight (PLBW) infants (ICD‐9‐code: 765.0x) in Taiwan. Methods: Based on Taiwan's National Health Insurance claim data, a population‐based cohort including a total of 18 421 PLBW infants born and hospitalized in 2000–02, was analyzed. The cumulative incidence rate (CIR) of readmission and the hazard ratio of readmission in relation to potential predictors were calculated. Results: The total number of participants readmitted within 15 or 31 days after discharge was 1763 and 2484, representing a CIR of 9.6% and 13.5%, respectively. Significant predictors for readmission within 15 or 31 days were essentially similar. Male gender, weight <1000 g, presence of congenital abnormalities, and lung disease were significant risk factors for readmission. Shorter length of hospital stay (<35 days) was associated with a reduced risk of readmission, and there were significant geographic and hospital variations of readmission, with higher rates noted in the most urbanized area and at regional hospitals. Conclusion: The short‐term readmission rate among Taiwanese PLBW infants is higher than in Western countries. Future studies should be conducted to investigate the causes of apparent geographic and hospital variations of readmission rates in order to make more specific interpretations.     

Early newborn hospital discharge and readmission for mild and severe jaundice

OBJECTIVES: To further explore the relationship of early newborn hospital discharge and readmission for jaundice, and to determine if early hospital discharge was associated with increased severity of jaundice among those readmitted. METHODS: We performed a population-based case-control study using Washington State vital statistics, birth certificates, and hospital discharge abstracts from 1991 to 1995. Cases included 750 infants readmitted to the hospital for jaundice in the first 2 weeks of life; controls included 3192 infants not readmitted. Infants with severe medical conditions and those delivered by cesarean section were excluded. Early hospital discharge was defined as fewer than 30 hours in the hospital, late hospital discharge, 30 to 78 hours. We assessed the risk for hospital readmission for jaundice, for hospital readmissions classified as brief (< or =2 days) or prolonged (>2 days), and for hospital readmissions classified as uncomplicated or complicated. RESULTS: Infants discharged from the hospital early were at increased risk for jaundice (odds ratio, 1.34 [95% confidence interval, 1.10-1.64] adjusted for birth year, gestational age, maternal race and age, parity, payer, and infant sex). The risk associated with early hospital discharge was similar regardless of whether the hospital readmission was brief or prolonged and complicated or uncomplicated. One hundred twenty-two infants would have to stay for longer than 30 hours to avoid 1 jaundice readmission. CONCLUSIONS: While newborns discharged from the hospital early are at increased risk for hospital readmission for jaundice, the clinical significance is limited. Mandating longer neonatal stays may not be the most effective strategy to prevent hospital readmission for jaundice and its complications.     

胎龄<32周早产儿中重度支气管肺发育不良危险因素的多中心回顾性分析

目的 分析胎龄<32周早产儿中重度支气管肺发育不良（bronchopulmonary dysplasia,BPD）的危险因素。 方法 回顾性收集2019年1月1日至2020年12月31日江苏省新生儿围产期协作网17家单位新生儿重症监护室收治的胎龄<32周且住院时间≥28 d诊断为BPD早产儿的临床资料,依据胎龄和BPD严重程度分组,采用多因素logistic回归分析不同胎龄段发生中重度BPD的危险因素。 结果 2年间17家协作单位新生儿重症监护室收治的胎龄<32周早产儿共2 603例,诊断BPD的961例,BPD发生率为36.92%（961/2 603）,中重度发生率为8.64%（225/2 603）,24⁺⁰~25⁺⁶周早产儿中重度BPD发生率为56.5%（26/46）,26⁺⁰~27⁺⁶周早产儿中重度BPD发生率为31.0%（66/213）,28⁺⁰~29⁺⁶周早产儿中重度BPD发生率为16.9%（75/445）,30⁺⁰~31⁺⁶周早产儿中重度BPD发生率为22.6%（58/257）。多因素logistic回归分析显示,各胎龄段早产儿中重度BPD危险因素不尽相同：24⁺⁰~25⁺⁶周为需治疗的动脉导管未闭;26⁺⁰~27⁺⁶周为胎膜早破≥18 h、复苏正压通气、临床败血症、机械通气时间≥14 d;28⁺⁰~29⁺⁶周为机械通气时间≥14 d、新生儿肺炎、需治疗的动脉导管未闭;30⁺⁰~31⁺⁶周为复苏正压通气、新生儿肺炎、早产儿贫血（均P<0.05）。 结论 胎龄<32周早产儿中重度BPD是多种因素共同作用的结果,并且每个胎龄段存在不尽相同的高危因素,对不同胎龄段提前采取有针对性举措,将有助于减轻BPD严重程度。     

Length of stay, jaundice, and hospital readmission

OBJECTIVE: To evaluate the effect of postnatal age at the time of discharge on the risk of readmission to hospital with specific reference to readmission for hyperbilirubinemia. DESIGN: Case-control study based on chart review. SETTING: Large suburban community hospital in southeastern Michigan, delivering more than 5000 infants annually. PATIENTS: Newborn infants, born between December 1, 1988, and November 30, 1994, who were readmitted to hospital within 14 days of discharge, were compared with a randomly selected control group who were not readmitted. RESULTS: Of 29,934 infants discharged, 247 (0.8%) were readmitted by the age of 14 days. One hundred twenty-seven (51%) were admitted because of hyperbilirubinemia and 74 (30%) with the diagnosis of "rule out sepsis." The factors associated with an increased risk of readmission to the hospital were: infant of diabetic mother [odds ratios (OR), 3.45; 95% confidence limits (CL), 1.39 to 8.60]; gestation < or = 36 weeks (OR, 4.56; CL, 1.45 to 14.33), and 37 1/7 to 38 weeks (OR, 2.95; CL, 1.63 to 5.35) versus > or = 40 weeks; presence of jaundice in the nursery (OR, 1.73; CL, 1.14 to 2.63); breastfeeding (OR, 1.78; CL, 1.13 to 2.81); male sex (OR, 1.58; CL, 1.07 to 2.34); length of stay < 48 hours (OR, 1.91; CL, 1.15 to 3.16) and 48 to < 72 hours (OR, 2.09; CL, 1.25 to 3.50) versus > or = 72 hours. Factors associated with readmission for jaundice were gestation < or = 36 weeks (OR, 13.2; CL, 2.70 to 64.6), 36 1/7 to 37 weeks (OR, 7.7; CL, 2.69 to 22.0), 37 1/7 to 38 weeks (OR, 7.2; CL, 3.05 to 16.97) versus > or = 40 weeks; jaundice during nursery stay (OR, 7.80; CL, 3.38 to 18.0); length of stay < 48 hours (OR, 2.40; CL, 1.09 to 5.30) and 48 to < 72 hours (OR, 3.15; CL, 1.40 to 7.09) versus > or = 72 hours; male sex (OR, 2.89; CL, 1.46 to 5.74); and breastfeeding (OR, 4.21; CL, 1.80 to 9.87). Infants whose length of stay was < 48 hours were at no greater risk for readmission for jaundice or other causes than those whose length of stay was > or = 48 hours to < 72 hours. CONCLUSIONS: Discharge at any time < 72 hours significantly increases the risk for readmission to hospital and the risk for readmission with hyperbilirubinemia when compared with discharge after 72 hours. The American Academy of Pediatrics recommends that infants discharged < 48 hours should be seen by a health care professional within 2 to 3 days of discharge. Our observations, as well as those of others, suggest that this recommendation should also be extended to those discharged at < 72 hours after birth. One approach to decreasing the risk of morbidity and readmission, particularly from hyperbilirubinemia, would be to help mothers to nurse their infants more effectively from the moment of birth.     

Day of discharge and hospital readmission rates within 30 days in children: A population-based study

BACKGROUND

Adults discharged from hospital on a Friday are more likely to be readmitted within 30 days than are adults discharged midweek. No study has examined readmission rates for children by day of discharge.

OBJECTIVE

To determine the risk of readmission within 30 days by day of discharge in the paediatric population.

METHODS

The Canadian Institute for Health Information provided data on children 29 days to 18 years of age who were discharged from hospitals in Ontario between January 1996 and December 2000. Two groups of children (those who were readmitted within 30 days and those who were not) were compared on demographic and clinical characteristics. Multivariable modelling was used to account for potential confounding variables: age, sex, length of hospital stay, number of diagnoses, in-hospital operative procedure, in-hospital complication and hospital admission in the previous six months.

RESULTS

A total of 506,035 hospitalizations (involving 334,959 children) occurred over the study period. Of these children, 3.4% were readmitted within 30 days of discharge. In total, 3.6% of children discharged on a Friday were readmitted within 30 days compared with 3.3% of children discharged on a Wednesday. After adjusting for patient and hospital factors, Friday discharge was not associated with readmission within 30 days (adjusted RR 1.07, 95% CI 0.99 to 1.15). More significant predictors of readmission included number of diagnoses, in-hospital complications and hospital admission in the six months previous to the index admission date.

CONCLUSION

Risk of readmission within 30 days is not significantly increased for children discharged on a Friday compared with children discharged midweek. Significant risk factors for hospital readmission are patient complexity and disease severity.     

Hospital readmission following pediatric heart transplantation

The frequency, indications, and outcomes for readmission following pediatric heart transplantation are poorly characterized. A better understanding of this phenomenon will help guide strategies to address the causes of readmission. Data from the Clinical Trials in Organ Transplantation for Children (CTOTC‐04) multi‐institutional collaborative study were utilized to determine incidence of, and risk factors for, hospital readmission within 30 days and 1 year from initial hospital discharge. Among 240 transplants at 8 centers, 227 subjects were discharged and had follow‐up. 129 subjects (56.8%) were readmitted within one year; 71 had two or more readmissions. The 30‐day and 1‐year freedom from readmission were 70.5% (CI: 64.1%, 76.0%) and 42.2% (CI: 35.7%, 48.7%), respectively. The most common indications for readmissions were infection followed by rejection and fever without confirmed infection, accounting for 25.0%, 10.6%, and 6.2% of readmissions, respectively. Factors independently associated with increased risk of first readmission within 1 year (Cox proportional hazard model) were as follows: transplant in infancy (P = .05), longer transplant hospitalization (P = .04), lower UNOS urgency status (2/IB vs 1A) at transplant (P = .04), and Hispanic ethnicity (P = .05). Hospital readmission occurs frequently in the first year following discharge after heart transplantation with highest risk in the first 30 days. Infection is more common than rejection as cause for readmission, with death during readmission being rare. A number of patient factors are associated with higher risk of readmission. A fuller understanding of these risk factors may help tailor strategies to reduce unnecessary hospital readmission.     

Newborn hospitalization: a closer look

To assess the safety of moderately early hospital discharge for normal newborn infants (mean +/- SD, 31 +/- 5 hours after delivery), we compared the incidence of hospital readmission within 6 weeks of birth with the incidence of readmission among a similar cohort of infants with extended hospitalization (mean +/- SD, 92 +/- 44 hours) as a result of maternal illness. The hospital charts for all infants admitted to the well-baby nursery between January 1 and December 31, 1985, were reviewed. Fifty-two (3.0%) of the 1714 infants who were discharged moderately early and 17 (2.7%) of the 622 infants who had an extended hospitalization were readmitted to the hospital by age 6 weeks (P = NS). Maternal age, financial status, and race each failed to predict infant readmission. Only four of the 52 readmission diagnoses among infants discharged moderately early could potentially have been identified (not prevented) before discharge with an extended newborn hospitalization. These data indicate that moderately early neonatal hospital discharge does not result in an increased incidence of rehospitalization within the first 6 weeks of life.