Predictors of mortality and length of stay for neonates admitted to children's hospital neonatal intensive care units
Predictors of mortality and length of stay for neonates admitted to children's hospital neonatal intensive care units
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DOI：
10.1038/sj.jp.7211904
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发表时间：
2008-04-01
影响因子：
2.9
通讯作者：
Hellmann, J.
中科院分区：
文献类型：
--
作者：
Berry, M. A.;Shah, P. S.;Hellmann, J.
目的：目前的评分系统，调整预测疾病的严重程度，不占较高的新生儿重症监护室（NICU）的儿童医院比围产期中心观察到的死亡率。我们假设，三个潜在的预测因素，（一）从另一个新生儿重症监护室，（B）存在先天性异常和（c）需要手术，将修改预期的死亡率和/或住院时间的婴儿入住新生儿重症监护室在儿童hospital.Study设计：我们回顾了连续入院两个新生儿重症监护室在加拿大儿童医院。我们进行了回归分析，以评估这些潜在的预测因子和疾病严重程度指数的死亡率和stay.Result的结果：625新生儿入院，从另一个NICU，先天性畸形需要入院和手术确定371（59%）。使用逻辑回归，根据从另一个新生儿重症监护室入院预测死亡率（比值比（OR）1.92; 95%置信区间（CI）1.04，3.57），先天性畸形（OR 7.28; 95%CI 3.69，14.36）和经验证的疾病严重程度评分，新生儿急性生理学评分围产期扩展版本II（SNAPPE- II; OR 1.07; 95% CI 1.05，1.09/点）。相比之下，手术干预可预测生存率（OR 0.35; 95% CI 0.18，0.67）。SNAPPE- II预测住院时间>= 21天（OR 1.02; 95% CI 1.01，1.03/点），先天性畸形（OR 2.47; 95% CI 1.60，3.79）和手术（OR 2.73; 95% CI 1.77，4.21）。NICU与不同病例组合（如儿童医院和围产期NICU）的公平性能比较，除了疾病严重程度指数外，还应考虑到从另一个新生儿重症监护室入院，先天性异常和手术。
Objective: Current scoring systems, which adjust prediction for severity of illness, do not account for higher observed mortality in neonatal intensive care units ( NICUs) of children's hospitals than that of perinatal centers. We hypothesized that three potential predictors, ( a) admission from another NICU, ( b) presence of congenital anomalies and ( c) need for surgery, would modify expected mortality and/ or length of stay for infants admitted to NICUs in children's hospitals.Study Design: We reviewed consecutive admissions to two NICUs in children's hospitals in Canada. We performed regression analyses to evaluate these potential predictors and severity- of- illness indices for the outcomes of mortality and length of stay.Result: Of 625 neonatal admissions, transfer from another NICU, congenital anomalies requiring admission and surgery were identified in 371 ( 59%). Using logistic regression, mortality was predicted based on admission from another NICU ( odds ratio ( OR) 1.92; 95% confidence interval ( CI) 1.04, 3.57), congenital anomalies ( OR 7.28; 95% CI 3.69, 14.36) and a validated severity- of- illness score, the Score for Neonatal Acute Physiology Perinatal Extension Version II ( SNAPPE- II; OR 1.07; 95% CI 1.05, 1.09 per point). By contrast, surgical intervention was predictive of survival ( OR 0.35; 95% CI 0.18, 0.67). Length of stay >= 21 days was predicted by SNAPPE- II ( OR 1.02; 95% CI 1.01, 1.03 per point), congenital anomalies ( OR 2.47; 95% CI 1.60, 3.79) and surgery ( OR 2.73; 95% CI 1.77, 4.21).Conclusion: Fair performance comparisons of NICUs with different case-mixes, such as children's hospital and perinatal NICUs, in addition to severity- of- illness indices, should account for admissions from another NICU, congenital anomalies and surgery.