Surfactant use for premature infants with respiratory distress syndrome in three New York city hospitals: discordance of practice from a community clinician consensus standard.
Surfactant use for premature infants with respiratory distress syndrome in three New York city hospitals: discordance of practice from a community clinician consensus standard.
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DOI：
10.1038/jp.2010.6
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发表时间：
2010-09
影响因子：
2.9
通讯作者：
Chassin, M. R.
中科院分区：
文献类型：
--
作者：
Howell, E. A.;Holzman, I.;Kleinman, L. C.;Wang, J.;Chassin, M. R.
评估与当地制定的呼吸窘迫综合征（RDS）早产儿护理标准的一致性，该标准建议在出生后两小时内对其进行表面活性剂治疗，并检查与标准不一致的临床、人口统计学和医院特征之间的关系。对1999年至2002年间在纽约市三家医院中出生的773名体重≤1750克的婴儿进行回顾性队列研究。773例患儿中227例（29%）符合治疗标准。其中37%的人在两小时内接受表面活性剂的治疗。4小时后，70%符合标准的婴儿接受了表面活性剂治疗。白人婴儿比非裔美国婴儿（61%）或拉丁裔婴儿（67%）更可能接受4小时表面活性剂（85%）。多变量logistic回归显示，非裔美国人种族（4.10,95% CI 1.30-13.00）、100克出生体重（OR为1.22,95% CI 1.10-1.34）和出生医院的比值比与宽松标准（4小时）存在显著差异。许多患有RDS的婴儿未能在出生后2和4小时接受表面活性剂替代治疗。非裔美国人和那些体型较大的人接受表面活性剂的可能性较小。如果这些数据可以推广，那么通过增加表面活性剂给婴儿的比率和速度，就有很大的机会减少RDS的婴儿发病率，并减少出生结果的种族/民族差异。
To assess concordance with a locally developed standard of care for premature infants with respiratory distress syndrome (RDS) for whom the standard recommends surfactant treatment within two hours of birth, and to examine the association between clinical, demographic, and hospital characteristics with discordance from the standard. Retrospective cohort study of 773 infants weighing ≤ 1750 grams born in any of three New York City hospitals between 1999 and 2002. 227 of the 773 infants (29%) met criteria for treatment according to the standard. Of these, 37% received surfactant by two hours. By four hours, 70% of infants who met the standard received surfactant. White infants were more likely to receive surfactant by 4 hours (85%) than African American (61%) or Latino infants (67%). Multivariable logistic regression revealed significant odds ratios predicting discordance from the relaxed criteria (4 hours) for: African American race (4.10, 95% CI 1.30–13.00), 100 grams of birth weight (OR of 1.22, 95% CI 1.10–1.34), and hospital of birth. Many infants with RDS failed to receive surfactant replacement therapy at 2 and 4 hours after birth. African Americans and those born larger were less likely to receive surfactant. If these data can be generalized, there is a large opportunity to reduce infant morbidity from RDS and to reduce racial/ethnic disparities in birth outcomes by increasing the rate and speed with which surfactant is delivered to these infants.
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DOI：
10.1038/sj.jp.7211320
发表时间：
2005-05-01
期刊：
Journal of perinatology : official journal of the California Perinatal Association
影响因子：
--
作者：
Suresh, Gautham K;Soll, Roger F
通讯作者：
Soll, Roger F
影响因子：
120.7
作者：
Rogowski, JA;Horbar, JD;Geppert, J
通讯作者：
Geppert, J
影响因子：
158.5
作者：
Hamvas, A;Wise, PH;Cole, FS
通讯作者：
Cole, FS
影响因子：
9.7
作者：
Rogowski, JA;Staiger, DO;Horbar, JD
通讯作者：
Horbar, JD
影响因子：
105.7
作者：
Horbar, JD;Carpenter, JH;Sinclair, JC
通讯作者：
Sinclair, JC