Hospital Variation and Risk Factors for Bronchopulmonary Dysplasia in a Population-Based Cohort
Hospital Variation and Risk Factors for Bronchopulmonary Dysplasia in a Population-Based Cohort
复制标题
DOI：
10.1001/jamapediatrics.2014.3676
复制
发表时间：
2015-02-01
期刊：
影响因子：
26.1
通讯作者：
Lee, Henry C.
中科院分区：
文献类型：
--
作者：
Lapcharoensap, Wannasiri;Gage, Susan C.;Lee, Henry C.
重要性 支气管肺发育不良 (BPD) 仍然是极低出生体重 (VLBW) 婴儿（< 1500 克）的严重发病率。新生儿护理的去区域化导致越来越多的 VLBW 婴儿在社区医院接受治疗，对 BPD 发展的影响未知。 目的 确定加州围产期质量护理合作组织内各级新生儿重症监护病房 (NICU) 中 BPD 发生的个体危险因素和 BPD 发生率的医院差异。 设计、设置和参与者 回顾性队列研究（2007 年 1 月至 2011 年 12 月）加州围产期质量护理合作组织包括加州 90% 以上的新生儿重症监护室 (NICU)。符合条件的极低出生体重儿出生在胎龄 22 至 29 周之间。暴露情况不同级别的重症监护。主要结果和措施支气管肺发育不良的定义为在 36 周月经后持续补充氧气。使用 36 周前 BPD 或死亡率的综合结果。使用多变量逻辑回归将医院视为随机效应，将胎龄视为危险因素，用于评估 BPD 的个体危险因素。该模型用于确定各医院的 BPD 风险调整率，并评估护理水平与 BPD 率之间的关联。 结果 研究队列包括 15 779 名婴儿，其中 1534 名婴儿在月经后 36 周之前死亡。共有 7081 名婴儿（即 44.8%）在 36 周前达到了 BPD 或死亡的主要结局。 116 个 NICU 的综合 BPD 或死亡率从 17.7% 到 73.4% 不等（四分位数范围，38.7%-54.1%）。与 IV 级 NICU 相比，II 级 NICU 发生 BPD 的风险较高（比值比，1.23；95% CI，1.02-1.49），而 III 级 NICU 发生 BPD 的风险相似（比值比，1.04；95% CI，0.95-1.14）。 结论和相关性 36 周前支气管肺发育不良或死亡加州约 45% 的 VLBW 婴儿受到月经后年龄的影响。各医院边缘性人格障碍发生率的巨大差异可以帮助我们深入了解潜在风险或预防因素。此外，我们的研究结果表明，加强 NICU 护理的区域化可能会减少 VLBW 婴儿的 BPD。
IMPORTANCE Bronchopulmonary dysplasia (BPD) remains a serious morbidity in very low-birth-weight (VLBW) infants (< 1500 g). Deregionalization of neonatal care has resulted in an increasing number of VLBW infants treated in community hospitals with unknown impact on the development of BPD.OBJECTIVE To identify individual risk factors for BPD development and hospital variation of BPD rates across all levels of neonatal intensive care units (NICUs) within the California Perinatal Quality Care Collaborative.DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study (January 2007 to December 2011) from the California Perinatal Quality Care Collaborative including more than 90% of California's NICUs. Eligible VLBW infants born between 22 to 29 weeks' gestational age.EXPOSURES Varying levels of intensive care.MAIN OUTCOMES AND MEASURES Bronchopulmonary dysplasia was defined as continuous supplemental oxygen use at 36 weeks' postmenstrual age. A combined outcome of BPD or mortality prior to 36 weeks was used. Multivariable logistic regression accounting for hospital as a random effect and gestational age as a risk factor was used to assess individual risk factors for BPD. This model was applied to determine risk-adjusted rates of BPD across hospitals and assess associations between levels of care and BPD rates.RESULTS The study cohort included 15 779 infants, of which 1534 infants died prior to 36 weeks' postmenstrual age. A total of 7081 infants, or 44.8%, met the primary outcome of BPD or death prior to 36 weeks. Combined BPD or death rates across 116 NICUs varied from 17.7% to 73.4%(interquartile range, 38.7%-54.1%). Compared with level IV NICUs, the risk for developing BPD was higher for level II NICUs (odds ratio, 1.23; 95% CI, 1.02-1.49) and similar for level III NICUs (odds ratio, 1.04; 95% CI, 0.95-1.14).CONCLUSIONS AND RELEVANCE Bronchopulmonary dysplasia or death prior to 36 weeks' postmenstrual age affects approximately 45% of VLBW infants across California. The wide variability in BPD occurrence across hospitals could offer insights into potential risk or preventive factors. Additionally, our findings suggest that increased regionalization of NICU care may reduce BPD among VLBW infants.