Inter-neonatal intensive care unit variation in discharge timing: Influence of apnea and feeding management
Inter-neonatal intensive care unit variation in discharge timing: Influence of apnea and feeding management
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DOI：
10.1542/peds.108.4.928
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发表时间：
2001-10-01
期刊：
影响因子：
8
通讯作者：
Richardson, DK
中科院分区：
文献类型：
--
作者：
Eichenwald, EC;Blackwell, M;Richardson, DK
背景早产儿在安全出院回家之前，需要达到医学稳定和成熟里程碑（特别是独立的体温调节，早产儿呼吸暂停的解决，以及经口进食的能力）。目前的做法也要求早产儿在出院前在医院观察几天（安全边际），在生理成熟后被认可。比较在不同新生儿重症监护室（NICU）接受护理的同质早产儿人群出院时的经后年龄（PMA），并评估识别和记录生理成熟度和所需安全边际对住院时间的影响。我们研究了胎龄为30至34 6/7周（GA）的早产儿，无明显的内科或外科并发症。收集1997年7月以前从马萨诸塞州15个NICU（9个2级，6个3级）中连续出院的符合条件的30例婴儿的病历资料。共有435名婴儿被纳入研究样本。研究人群的平均（+/-标准差）GA和出生体重分别为33.2 +/- 1.2周和2024 +/- 389 g。无论出生时GA如何，婴儿均在相似的PMA下出院。观察到出院时不同医院研究中心的PMA存在相当大的差异（范围：35.2 +/- 0.5周至36.5 +/- 1.2周）。尽管研究人群具有同质性，但在出院时有最新PMA的婴儿的医院也记录了年龄较大时成熟的心肺和喂养行为。较长的脉搏血氧饱和度测定持续时间与呼吸暂停的后期解决相关。研究中心之间安全范围持续时间的差异并不影响住院时间的变化。NICU对健康早产儿的住院时间长短差异很大。我们推测，这种变化的结果部分来自早产儿呼吸暂停和喂养行为的监测和记录的差异。
Background. Premature infants need to attain both medical stability and maturational milestones (specifically, independent thermoregulation, resolution of apnea of prematurity, and the ability to feed by mouth) before safe discharge to home. Current practice also requires premature infants to be observed in hospital before discharge for several days (margin of safety) after physiologic maturity is recognized.Objective. To compare postmenstrual age (PMA) at discharge in a homogeneous population of premature infants cared for in different neonatal intensive care units (NICUs) and to assess the impact on hospital stay of the recognition and recording of physiologic maturity and the required margin of safety.Methods. We studied premature infants delivered at 30 to 34 6/7 weeks gestational age (GA), free of significant medical or surgical complications. Medical records of 30 eligible infants consecutively discharged from the hospital before July 1997 from each of 15 NICUs in Massachusetts (9 level 2 and 6 level 3) were reviewed.Results. A total of 435 infants were included in the study sample. Mean (+/- standard deviation) GA and birth weight of the study population were 33.2 +/- 1.2 weeks and 2024 +/- 389 g, respectively. Infants were discharged at a similar PMA regardless of GA at birth. Considerable variation in the PMA at discharge between hospital sites was observed (range, 35.2 +/- 0.5 weeks to 36.5 +/- 1.2 weeks). Despite the homogeneous study population, hospitals in which infants had the latest PMA at discharge also recorded mature cardiorespiratory and feeding behavior at an older age. Longer duration of pulse oximetry use was associated with later resolution of apnea. Differences in the duration of the margin of safety between sites did not contribute to variation in hospital stay.Conclusion. NICUs vary widely in length of hospital stay for healthy premature infants. We speculate that this variation results in part from differences in monitoring for and documentation of apnea of prematurity and feeding behavior.