PHYSIOLOGICAL SEVERITY INDEX FOR NEONATAL INTENSIVE CARE

新生儿重症监护病房(NICU)已经证明 有效降低新生儿死亡率和发病率。然而， 不同机构之间的存活率和结果存在显著差异 在根据出生体重、性别和种族进行调整后得到了证实。 这些差异不仅在临床上有显著意义，而且 可能还会对公共健康甚至经济产生严重影响 看得最多的是NICU的极高护理。这是至关重要的 制定疾病严重程度指数，以便准确 不同医院间NICU护理的比较研究 地区，以及随着时间的推移。严重程度量表已为以下方面制定 成人和儿科重症监护依赖于 个别患者的生理异常。这些分数 面对治疗风格的变化，往往会表现得很健壮 或诊断惯例。这样的规模还没有 尝试新生儿重症监护，部分原因是 是否有一个强有力的预测指标，出生体重。我们建议 开发这样一个基于生理学的疾病严重程度指数 在我们的三年内的两年内进行新生儿重症监护- NICU系统。 研究策略将是开发一种使用 专家小组和名义上的分组技术。计分项目将 包括基本的物理和实验室测量。之后 测试可靠性，它将在一个有前景的应用 在我们的三个NICU住了一年。有效性将由 预测死亡率和不良后果的能力。它还将 与其他严重程度的标志进行比较，包括 重症监护的治疗强度、护理敏锐度、并发症 护理(医院内败血症)和住院费。进一步 精细化将通过多变量逐步建模来实现。这个 指数的成功与否将由其解释能力来评估 已知主要风险因素后的剩余方差 (出生体重、种族、性别、繁殖率)已输入。这个 然后，专家小组将再次召开会议，评估由此产生的比额表 并建议进行最终修改。

Neonatal Intensive Care Units (NICUs) have proven remarkably effective in lowering neonatal mortality and morbidity. Yet, marked variations in survival and outcome among institutions have been demonstrated when adjusted for birthweight, sex, and race. Not only are these disparities significant clinically, but they may also have serious public health and even economic impact in view of the extremely high most of NICU care. It is essential to develop a severity of illness index in order to permit accurate comparative studies of NICU care between hospitals, across regions, and over time. Severity scales have been developed for adult and pediatric intensive care which rely on the degree on physiologic abnormality of the individual patients. These scores tend to be robust in the face of variations in therapeutic style or diagnostic conventions. Such scales have not yet been attempted for neonatal intensive care, in part because of the availability of a strong predictor, birthweight. We propose to develop such a physiology based severity of illness index for neonatal intensive care over a two year period within our three- NICU system. The research strategy will be to develop an instrument using an expert panel and nominal group techniques. Score items will include basic physical and laboratory measurements. After testing reliability, it will be applied prospectively for one year in our three NICUs. Validity will be assessed by the ability to predict mortality and adverse outcomes. It will also be compared against other markers of severity including therapeutic intensity, nursing acuity, complications of intensive care (nosocomial sepsis), and hospital charges. Further refinement will come through multivariate stepwise modeling. The success of the index will be assessed by it ability to explain the variance remaining after the known major risk factors (birthweight, race, sex, plurality) have been entered. The expert panel will then reconvene to evaluate the resulting scale and recommend final revisions.