Van Marter L J, Pagano M, Allred E N, Leviton A, Kuban K C
Division of Newborn Medicine and Neuroepidemiology, Children's Hospital, Boston, Massachusetts 02115.
J Pediatr. 1992 Jun;120(6):938-46. doi: 10.1016/s0022-3476(05)81968-7.
Some differences among neonatal intensive care units (NICUs) in incidence of bronchopulmonary dysplasia may reflect variations in medical care practices. After adjusting for differences in the inherent risk of bronchopulmonary dysplasia among 223 infants of less than 1751 gm birth weight who were admitted to three Harvard-affiliated NICUs, we used multivariate analysis to explore the extent to which medical care practices during the first days of life varied with the rate of bronchopulmonary dysplasia. In our analyses, variables were grouped by three major hypotheses: oxygen toxicity, barotrauma, and fluid overload. The NICU designated 1 (the one with the highest rate of bronchopulmonary dysplasia) used much higher than expected colloidal volumes during the first 4 days of life; in contrast, in the NICU designated 3 (the one with the lowest rate of bronchopulmonary dysplasia), infants consistently received lower than expected amounts of colloidal solution. Signs of patent ductus arteriosus were also much more frequent than expected during this time at NICU 1; rates were much lower than predicted at NICU 2 and were near predicted values at NICU 3. Maximum inspired oxygen fraction during the first 4 days varied significantly in a direction inconsistent with the oxygen toxicity hypothesis. Maximum arterial oxygen tension was significantly less than expected at the hospital with the lowest rate of bronchopulmonary dysplasia (NICU 3). None of six medical care practices indicating potential for barotrauma varied with NICU expect for positive end-expiratory pressure, which varied in a direction suggesting a protective effect against bronchopulmonary dysplasia. These findings agree best with the hypothesis that differences in hydration during the first days of life account for some of the difference among NICUs in bronchopulmonary dysplasia occurrence.
新生儿重症监护病房（NICU）之间支气管肺发育不良发病率的一些差异可能反映了医疗护理实践的不同。在对223名出生体重小于1751克、入住三家哈佛附属NICU的婴儿中支气管肺发育不良的固有风险差异进行校正后，我们使用多变量分析来探究出生后最初几天的医疗护理实践随支气管肺发育不良发生率变化的程度。在我们的分析中，变量按照三个主要假设进行分组：氧中毒、气压伤和液体超负荷。被指定为1号的NICU（支气管肺发育不良发生率最高的那家）在出生后的头4天使用的胶体量远高于预期；相比之下，在被指定为3号的NICU（支气管肺发育不良发生率最低的那家），婴儿持续接受的胶体溶液量低于预期。在这段时间里，1号NICU动脉导管未闭的体征也比预期频繁得多；2号NICU的发生率远低于预测值，3号NICU的发生率接近预测值。头4天的最大吸入氧分数变化显著，其变化方向与氧中毒假设不一致。支气管肺发育不良发生率最低的医院（3号NICU）的最大动脉血氧张力明显低于预期。除呼气末正压外，表明存在气压伤可能性的六种医疗护理实践中没有一种随NICU不同而变化，呼气末正压的变化方向表明其对支气管肺发育不良有保护作用。这些发现最符合以下假设：出生后最初几天的液体补充差异是各NICU支气管肺发育不良发生率存在差异的部分原因。
