Does hospital transfer predict mortality in very low birth weight infants requiring surgery for necrotizing enterocolitis?
Does hospital transfer predict mortality in very low birth weight infants requiring surgery for necrotizing enterocolitis?
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DOI：
10.1016/j.surg.2012.05.036
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发表时间：
2012-09
期刊：
影响因子：
3.8
通讯作者：
Shew, Stephen B.
中科院分区：
文献类型：
--
作者：
Kelley-Quon, Lorraine I.;Tseng, Chi-Hong;Scott, Andrew;Jen, Howard C.;Calkins, Kara L.;Shew, Stephen B.
坏死性小肠结肠炎（NEC）是婴儿死亡的主要原因，也是极低出生体重（VLBW, <1500g）婴儿紧急手术的最常见原因。我们调查了转移到更高水平的外科护理是否会影响这一人群的死亡率。从加利福尼亚患者出院相关出生队列数据库（1999-2007）对接受NEC手术的VLBW婴儿进行回顾性分析。急诊手术转移定义为转移后手术≤2d。死亡率采用多因素logistic回归分析。总的来说，1272名患有手术性NEC的VLBW婴儿被确定为39%的死亡率。406例（32%）婴儿发生手术转移。转移的婴儿与未转移的婴儿的未调整死亡率没有增加，分别为37%对40% （p=0.25）。转手术婴儿的调整死亡率与在原NICU接受手术婴儿的调整死亡率无差异（OR 0.75, 95% CI 0.42-1.32）。低出生体重、缺乏产前护理、腹膜引流作为唯一的手术干预和肺间质性肺气肿/肺出血与死亡率增加相关（p<0.05）。患有外科NEC的VLBW婴儿在紧急转移手术时没有显示出死亡风险增加。今后的努力必须让照顾这一弱势群体的保健专业人员参与，以便最大限度地分配资源和保障安全。
Necrotizing enterocolitis (NEC) is a leading cause of infant mortality and the most common reason for emergent surgery in very low birth weight (VLBW, <1500g) infants. We investigated whether transfer for higher level of surgical care affects mortality in this population. VLBW infants who underwent NEC surgery were retrospectively reviewed from the California Patient Discharge Linked Birth Cohort Database (1999–2007). Transfer for emergent surgery was defined as surgery ≤2d after transfer. Mortality was analyzed with multivariate logistic regression. Overall, 1,272 VLBW infants with surgical NEC were identified with a 39% mortality. Transfer for surgery occurred in 406 (32%) infants. Unadjusted mortality was not increased for infants transferred versus not transferred, 37% vs. 40% (p=0.25). Adjusted mortality for infants transferred for surgery did not differ from those who received surgery at their primary NICU (OR 0.75, 95% CI 0.42–1.32). Lower birth weight, lack of prenatal care, peritoneal drainage as sole surgical intervention, and pulmonary interstitial emphysema/pulmonary hemorrhage were associated with increased odds of mortality (p<0.05). VLBW infants with surgical NEC do not demonstrate increased risk of mortality when transferred emergently for surgery. Future efforts must engage health professionals caring for this vulnerable population in order to maximize resource allocation and safety.
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影响因子：
105.7
作者：
BOWMAN, E;DOYLE, LW;KITCHEN, WH
通讯作者：
KITCHEN, WH
DOI：
10.1016/0002-9378(95)90653-3
发表时间：
1995-11-01
影响因子：
9.8
作者：
POWELL, SL;HOLT, VL;CONNELL, FA
通讯作者：
CONNELL, FA
影响因子：
2.9
作者：
Attridge, J. T.;Clark, R.;Gordon, P. V.
通讯作者：
Gordon, P. V.
DOI：
10.1038/sj.jp.7210824
发表时间：
2002-12-01
期刊：
Journal of perinatology : official journal of the California Perinatal Association
影响因子：
--
作者：
Gould, Jeffrey B;Marks, Amy R;Chavez, Gilberto
通讯作者：
Chavez, Gilberto
在有或没有现场手术设施的中心护理患有坏死性小肠结肠炎的极早产儿的结果
DOI：
10.1136/fn.85.2.f114
发表时间：
2001-09-01
影响因子：
4.4
作者：
Loh, M;Osborn, DA;Lui, K
通讯作者：
Lui, K