Variations in patterns of care across neonatal units and their associations with outcomes in very preterm infants: the French EPIPAGE-2 cohort study
Variations in patterns of care across neonatal units and their associations with outcomes in very preterm infants: the French EPIPAGE-2 cohort study
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DOI：
10.1136/bmjopen-2019-035075
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发表时间：
2020-06-01
期刊：
影响因子：
2.9
通讯作者：
Kaminski, Monique
中科院分区：
文献类型：
--
作者：
Pierrat, Veronique;Burguet, Antoine;Kaminski, Monique
目的描述新生儿重症监护病房（NICU）中极早产（VP）婴儿的护理模式及其与结局的相关性。设计前瞻性队列研究，EPIPAGE-2.设置法国，2011年。参与者53（NICU）; 2135名出生于27至31周的VP新生儿。结果测量单位群，由五个新生儿护理领域-呼吸，心血管、营养、疼痛管理和神经发育护理。死亡率在2年校正年龄（CA）或严重/中度神经运动或感觉残疾和神经发育年龄和阶段问卷（ASQ）的分数低于阈值的儿童的比例。在调整潜在的共同因素后，比较各组之间的结果。结果确定了三个组：组1，在出生后24小时内无机械通气的新生儿比例较高，接受早期肠内喂养，神经发育护理实践（26个单位; n=1118名婴儿）;第2组动脉导管未闭和疼痛筛查水平较高（11个单位; n=398名婴儿）;第3组呼吸、心血管和疼痛治疗使用率较高（16个单位; n=619名婴儿）。在基线母亲和婴儿特征的聚类之间没有观察到差异。集群1和集群3之间未观察到结局差异。与组1相比，组2中2年CA或重度/中度神经运动或感觉残疾的死亡率较低（校正OR 0.46，95% CI 0.25 - 0.84），但阿索低于阈值的儿童比例较高结论在法国新生儿重症监护病房，VP婴儿的护理实践是非随机相关的。集群之间的差异很难解释单位或人口的差异，但与死亡率和发展在2年。更好地理解这些差异可能有助于改善VPT婴儿的结果，因为其中一些差异可能是没有根据的。
Objectives To describe patterns of care for very preterm (VP) babies across neonatal intensive care units (NICUs) and associations with outcomes.Design Prospective cohort study, EPIPAGE-2.Setting France, 2011.Participants 53 (NICUs); 2135 VP neonates born at 27 to 31 weeks.Outcome measures Clusters of units, defined by the association of practices in five neonatal care domains - respiratory, cardiovascular, nutrition, pain management and neurodevelopmental care. Mortality at 2 years corrected age (CA) or severe/moderate neuro-motor or sensory disabilities and proportion of children with scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ).Methods Hierarchical duster analysis to identify clusters of units. Comparison of outcomes between clusters, after adjustment for potential cofounders.Results Three clusters were identified: Cluster 1 with higher proportions of neonates free of mechanical ventilation at 24 hours of life, receiving early enteral feeding, and neurodevelopmental care practices (26 units; n=1118 babies); Cluster 2 with higher levels of patent ductus arteriosus and pain screening (11 units; n=398 babies); Cluster 3 with higher use of respiratory, cardiovascular and pain treatments (16 units; n=619 babies). No difference was observed between clusters for the baseline maternal and babies' characteristics. No differences in outcomes were observed between Clusters 1 and 3. Compared with Cluster 1, mortality at 2 years CA or severe/moderate neuro-motor or sensory disabilities was lower in Cluster 2 (adjusted OR 0.46, 95% CI 0.25 to 0.84) but with higher proportion of children with an ASO below threshold (adjusted OR 1.49, 95% CI 1.07 to 2.08).Conclusion In French NICUs, care practices for VP babies were non-randomly associated. Differences between clusters were poorly explained by unit or population differences, but were associated with mortality and development at 2 years. Better understanding these variations may help to improve outcomes for VPT babies, as it is likely that some of these discrepancies are unwarranted.