Multiple Chronic Conditions in VLBW Infants: Epidemiology, NICU Care, and Outcome

说明(申请人提供)：早产及其并发症是导致儿童在出生后第一年死亡的主要原因，也是导致儿童终身患病的主要原因。早产儿和极低出生体重儿(PVLBW，定义为胎龄d 32周，出生体重d 1500克)在出生一年内死亡的可能性是正常婴儿的100倍，他们面临发育迟缓、功能障碍的高风险，并经常患有多种复杂的慢性疾病，影响肺、肠道、大脑、眼睛和其他器官。特别是，PVLBW儿童患有支气管肺发育不良(BPD)、坏死性小肠结肠炎(NEC)和脑室出血(IVH)的风险很高。我们建议对这些情况的共同发生进行流行病学描述，通过对2006年至2010年在33家儿童医院的33家儿童医院NICU收治的15470名早产儿进行二次分析，观察这些慢性疾病对在NICU接受护理的PVLBW婴儿的影响。值得关注的结果包括在NICU住院期间死亡、在NICU住院期间接受治疗的累积负担以及出院后30天内再次住院。我们将：1)描述PVLBW婴儿在首次NICU住院期间的慢性疾病的发生率，单独和合并。2)描述单独和合并的慢性疾病与首次入院NICU的三种结果之间的关系：在NICU住院期间死亡、在NICU住院期间接受治疗的累积负担以及出院后再次住院。3)我们将记录一项关键干预措施对结果的影响：使用吸入一氧化氮预防和治疗BPD。在美国，早产儿和极低出生体重儿的发生率都在上升。与美国其他人口相比，极低出生体重儿的发生率是黑人的2.5倍，因此是健康差距的一个重要载体。在所有分析中，我们将寻找基于种族或支付者地位的慢性病的不同发病率、结果、治疗或治疗效果的证据。我们还将寻找不同医院或地区在慢性病的发病率、结果或治疗方面的差异。由于PVLBW婴儿经常患有多种慢性疾病，在服务不足的社区中比例过高，他们是比较有效性研究的优先人群。这项拟议的研究将具有重要意义，因为它将首次在大样本中系统地描述PVLBW婴儿并发多种严重慢性疾病的发生率、结果和治疗，PVLBW婴儿是一个死亡率和发病率都很高的人群。 公共卫生相关性：项目叙述早产儿和极低出生体重(VLBW)婴儿死亡、发育迟缓、功能残疾的风险很高，而且往往有多种复杂的慢性疾病，包括支气管肺发育不良(BPD)、坏死性小肠结肠炎(NEC)和脑室出血(IVH)。我们建议通过对2006年至2010年间入住NICU的15470名早产儿进行二次分析，对这些情况的共同发生进行流行病学描述。值得关注的结果包括死亡、接受治疗的累积负担以及NICU出院后30天内再次住院。在美国，早产儿和极低出生体重正在上升。极低出生体重在黑人中的发生率是黑人的2.5倍，因此是健康差距的一个重要载体。由于PVLBW婴儿经常患有多种慢性疾病，在服务不足的社区中比例过高，他们是比较有效性研究的优先人群。

DESCRIPTION (provided by applicant): Prematurity and its complications are the leading causes of death among children in the first year of life and causes of morbidity lasting for the entire lifespan. Premature and very low birth weight infants (PVLBW, defined as gestational age d 32 weeks and birth weight d 1500g) are 100 times more likely than a normal infant to die in the first year of life, and they are at high risk for developmental delays, functional disabilities, and often have multiple complex chronic conditions affecting the lungs, gut, brain, eyes, and other organs. Specifically, PVLBW children are at high risk for bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and intraventricular hemorrhages (IVH). We propose to conduct an epidemiologic description of the co-occurrence of these conditions, through a secondary analysis of 15470 premature children admitted to NICUs from 2006- 2010 at 33 children's hospitals in the Pediatric Health Information System (PHIS) database, looking at the effects of these chronic conditions on PVLBW infants receiving care in NICUs. The outcomes of interest include death during the NICU stay, cumulative burden of therapies received during the NICU stay, and re- hospitalization within 30 days following discharge from the NICU. We will: 1) Describe the incidence of the chronic conditions among PVLBW infants during the initial NICU admission, singly and in combination. 2) Describe the associations between the chronic conditions, singly and in combination, and three outcomes of the first NICU admission: death during the NICU stay, the cumulative burden of therapies received during the NICU stay, and re-hospitalization following discharge from the NICU. 3) We will document the consequences of one key intervention on the outcomes: the use of inhaled Nitric Oxide to prevent and treat BPD. The rates of both prematurity and VLBW are rising in the U.S. VLBW occurs at > 2.5 times the rate among blacks compared to the rest of the U.S. population and is therefore a significant vector of health disparities. In all analyses, we will look for evidence of disparate incidence, outcomes, treatment or efficacy of treatment of the chronic conditions based on race or payer status. We will also look for hospital- or region-specific variation in the incidence, outcomes, or treatment of the chronic conditions. Because PVLBW babies are often subject to multiple chronic disorders and are over-represented in an underserved community, they are a priority population for comparative effectiveness research. The proposed study will be significant because it will be the first to systematically describe, in a large sample, the incidence, outcomes, and treatment of multiple co- occurring severe chronic conditions in PVLBW infants, a population experiencing significant mortality and morbidity. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE Premature and very low birth weight (VLBW) infants are at high risk for death, developmental delays, functional disabilities, and often have multiple complex chronic conditions, including bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and intraventricular hemorrhages (IVH). We propose to conduct an epidemiologic description of the co-occurrence of these conditions, through a secondary analysis of 15470 premature children admitted to NICUs from 2006-2010. The outcomes of interest include death, cumulative burden of therapies received, and re-hospitalization within 30 days following NICU discharge. Prematurity and VLBW are rising in the U.S. VLBW occurs at > 2.5 times the rate among blacks and is therefore a significant vector of health disparities. Because PVLBW babies are often subject to multiple chronic disorders and are over-represented in an underserved community, they are a priority population for comparative effectiveness research.