Covariation of Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Management and In-Neonatal Intensive Care Unit Outcomes Following Preterm Birth
Covariation of Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Management and In-Neonatal Intensive Care Unit Outcomes Following Preterm Birth
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DOI：
10.1016/j.jpeds.2018.07.025
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发表时间：
2018-12-01
影响因子：
5.1
通讯作者：
Lee, Henry C.
中科院分区：
文献类型：
--
作者：
Hagadorn, James, I;Bennett, Mihoko, V;Lee, Henry C.
目的验证新生儿重症监护病房（NICU）动脉导管未闭（PDA）处理特异性改变与早产儿局部预后改变相关的假设。研究设计：这项回顾性、重复测量的综合数据研究包括出生在400-1499克的婴儿，他们在出生后2天内入住新生儿重症监护病房，参与了加州围产期质量护理合作。2008-2015年被分为4个2年的时期。对于每个时期和新生儿重症监护病房，我们计算了接受环氧化酶抑制剂（COXI）或PDA结扎的婴儿比例，并确定了这些治疗在连续时期之间新生儿重症监护病房的特异性变化。使用广义估计方程来检验新生儿重症监护室PDA管理的特定变化与当地结果的同期变化之间的调整关系。结果我们纳入了119家医院的642例期间变化观察，总结了32 094例婴儿。新生儿重症监护室COXI使用和结扎的特异性变化与调整后局部预后的同期变化显示出显著的剂量-反应相关性。在400-749克出生的婴儿中，接受COXI或结扎治疗的新生儿重症监护病房比例每降低一个百分点，调整后的当地住院死亡率同期增加0.21个百分点（95% CI 0.06, 0.33: P = 0.005）。相比之下，新生儿新生儿重症监护病房特异性结扎率的降低与调整后的局部支气管肺发育不良（P= 0.009）和死亡或支气管肺发育不良（P= 0.01）的降低有关。结论新生儿重症监护病房的早产结局与局部PDA管理相关。一些出生在400-749克的婴儿可能会受益于PDA闭合治疗。新生儿重症监护病房COXI使用率或结扎率的降低与较大早产儿局部调整不良结局发生率的增加无关。
Objective To test the hypothesis that neonatal intensive care unit (NICU)-specific changes in patent ductus arteriosus (PDA) management are associated with changes in local outcomes in preterm infants.Study design This retrospective repeated-measures study of aggregated data included infants born 400-1499 g admitted within 2 days of delivery to NICUs participating in the California Perinatal Quality Care Collaborative. The period 2008-2015 was divided into four 2-year epochs. For each epoch and NICU, we calculated proportions of infants receiving cyclooxygenase inhibitor (COXI) or PDA ligation and determined NICU-specific changes in these therapies between consecutive epochs. Generalized estimating equations were used to examine adjusted relationships between NICU-specific changes in PDA management and contemporaneous changes in local outcomes.Results We included 642 observations of interepoch change at 119 hospitals summarizing 32 094 infants. NICU-specific changes in COXI use and ligation showed significant dose-response associations with contemporaneous changes in adjusted local outcomes. Each percentage point decrease in NICU-specific proportion treated with either COXI or ligation was associated with a 0.21 percentage point contemporaneous increase in adjusted local in-hospital mortality (95% CI 0.06, 0.33: P = .005) among infants born 400-749 g. In contrast, decreasing NICU-specific ligation rate among infants 1000-1499 g was associated with decreasing adjusted local bronchopulmonary dysplasia (P= .009) and death or bronchopulmonary dysplasia (P = .01).Conclusions NICU-specific outcomes of preterm birth co-vary with local PDA management. Treatment for PDA closure may benefit some infants born 400-749 g. Decreasing NICU-specific rates of COXI use or ligation were not associated with increases in local adjusted rates of examined adverse outcomes in larger preterm infants.