Clinical Predictors and Institutional Variation in Home Oxygen Use in Preterm Infants
Clinical Predictors and Institutional Variation in Home Oxygen Use in Preterm Infants
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DOI：
10.1016/j.jpeds.2011.08.033
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发表时间：
2012-02-01
影响因子：
5.1
通讯作者：
Spitzer, Alan
中科院分区：
文献类型：
--
作者：
Lagatta, Joanne;Clark, Reese;Spitzer, Alan
目的评估早产儿家庭氧气使用情况，确定预测家庭氧气使用的危险因素，并量化新生儿重症监护病房家庭氧气使用的制度差异程度。研究设计我们对2009年出生的23- 31周的幸存婴儿进行了回顾性队列分析，使用了来自儿科临床数据仓库的去识别电子病历信息。混合效应logistic回归量化影响家庭氧气使用的临床危险因素和制度差异。结果共发现8167例患儿。家庭供氧量因胎龄而异，从胎龄23至24周婴儿的59%到29至31周婴儿的7%。其他危险因素包括胎龄小、先天性异常、前72小时机械通气、前72小时吸入氧分数>.4和动脉导管未闭。在调整了临床风险因素后，各机构的家庭吸氧率仍有4- 5倍的差异。结论家庭吸氧在早胎龄婴儿和重度呼吸系统疾病婴儿中较为常见。制度差异占家庭氧气使用差异的4- 5倍。应告知家庭使用氧气的可能性，前瞻性研究必须确定高危婴儿的最佳治疗策略。[J] .中华儿科杂志（英文版）；2012;32(5):391 - 391。
Objective To assess home oxygen use in preterm infants, identify risk factors predicting home oxygen use, and quantify the extent of institutional variation in home oxygen use across neonatal intensive care units.Study design We conducted a retrospective cohort analysis of surviving infants of 23- to 31-week gestational age discharged home in 2009, with de-identified electronic medical record information from the Pediatrix Clinical Data Warehouse. Mixed-effects logistic regression quantified clinical risk factors and institutional variation affecting home oxygen use.Results A total of 8167 infants were identified. Home oxygen use varied by gestational age, from 59% of infants 23 to 24 weeks gestational age to 7% of infants 29 to 31 weeks gestational age. Other risk factors included small for gestational age, congenital anomalies, mechanical ventilation in the first 72 hours, fraction of inhaled oxygen >0.4 in the first 72 hours, and patent ductus arteriosus. After adjusting for clinical risk factors, there was still a 4- to 5-fold difference in institutions' odds of home oxygen use.Conclusions Home oxygen use was common in infants of earlier gestational ages and infants with more severe respiratory illness. Institutional variation accounted for 4- to 5-fold variation in home oxygen use. Families should be counseled about the likelihood of home oxygen use, and prospective research must identify optimal treatment strategies for high-risk infants. (J Pediatr 2012;160:232-8).