Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants
Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants
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DOI：
10.1056/nejmoa1410689
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发表时间：
2015-05-07
影响因子：
158.5
通讯作者：
Higgins, Rosemary D.
中科院分区：
文献类型：
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作者：
Rysavy, Matthew A.;Li, Lei;Higgins, Rosemary D.
背景极早产儿的结果在医院之间的差异很大程度上无法解释，可能反映了与出生后舒适护理相比，医院在开始积极救生治疗方面的做法差异。方法我们对尤尼斯·肯尼迪·施赖弗国家儿童健康和人类发展新生儿研究网络中包括的 24 家医院 2006 年 4 月至 2011 年 3 月期间出生的婴儿进行了研究。收集了 4987 名妊娠 27 周前出生的无先天异常婴儿的数据。积极治疗被定义为出生后进行的任何可能挽救生命的干预措施。对 4704 名儿童 (94.3%) 在 18 至 22 个月校正年龄时的生存和神经发育障碍进行了评估。结果 积极治疗的总体比率范围为妊娠 22 周出生的婴儿的 22.1%（四分位距 [IQR]，7.7 至 100）到 26 周出生的婴儿的 99.8%（IQR，100 至 100）。怀孕周数。妊娠 22 周出生的儿童的总体生存率和无严重损伤的生存率分别为 5.1%（IQR，0 至 10.6）和 3.4%（IQR，0 至 6.9），而妊娠 22 周出生的儿童的总体生存率和无严重损伤生存率分别为 81.4%（IQR，78.2 至 84.0）和 75.6%（IQR，69.5 至 80.0）。怀孕26周。在妊娠 22 周或 23 周出生的儿童中，积极治疗的住院率分别占医院间生存率和无严重损害生存率差异的 78% 和 75%，在妊娠 24 周出生的儿童中，分别占 22% 和 16%，但这些比率并没有解释妊娠 25 周或 26 周出生的儿童的任何结果差异。结论 医院在对妊娠 22、23 或 24 周出生的婴儿开始积极治疗方面的差异解释了此类患者的生存率和无损害生存率的医院间差异。 （由美国国立卫生研究院资助。）
BACKGROUNDBetween-hospital variation in outcomes among extremely preterm infants is largely unexplained and may reflect differences in hospital practices regarding the initiation of active lifesaving treatment as compared with comfort care after birth.METHODSWe studied infants born between April 2006 and March 2011 at 24 hospitals included in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Data were collected for 4987 infants born before 27 weeks of gestation without congenital anomalies. Active treatment was defined as any potentially lifesaving intervention administered after birth. Survival and neurodevelopmental impairment at 18 to 22 months of corrected age were assessed in 4704 children (94.3%).RESULTSOverall rates of active treatment ranged from 22.1% (interquartile range [IQR], 7.7 to 100) among infants born at 22 weeks of gestation to 99.8% (IQR, 100 to 100) among those born at 26 weeks of gestation. Overall rates of survival and survival without severe impairment ranged from 5.1% (IQR, 0 to 10.6) and 3.4% (IQR, 0 to 6.9), respectively, among children born at 22 weeks of gestation to 81.4% (IQR, 78.2 to 84.0) and 75.6% (IQR, 69.5 to 80.0), respectively, among those born at 26 weeks of gestation. Hospital rates of active treatment accounted for 78% and 75% of the between-hospital variation in survival and survival without severe impairment, respectively, among children born at 22 or 23 weeks of gestation, and accounted for 22% and 16%, respectively, among those born at 24 weeks of gestation, but the rates did not account for any of the variation in outcomes among those born at 25 or 26 weeks of gestation.CONCLUSIONSDifferences in hospital practices regarding the initiation of active treatment in infants born at 22, 23, or 24 weeks of gestation explain some of the between-hospital variation in survival and survival without impairment among such patients. (Funded by the National Institutes of Health.)