Medical College of Wisconsin, Milwaukee, WI 53204, USA.
J Pediatr. 2012 Feb;160(2):232-8. doi: 10.1016/j.jpeds.2011.08.033. Epub 2011 Sep 29.
To assess home oxygen use in preterm infants, identify risk factors predicting home oxygen use, and quantify the extent of institutional variation in home oxygen use across neonatal intensive care units.
We conducted a retrospective cohort analysis of surviving infants of 23- to 31-week gestational age discharged home in 2009, with de-identified electronic medical record information from the Pediatrix Clinical Data Warehouse. Mixed-effects logistic regression quantified clinical risk factors and institutional variation affecting home oxygen use.
A total of 8167 infants were identified. Home oxygen use varied by gestational age, from 59% of infants 23 to 24 weeks gestational age to 7% of infants 29 to 31 weeks gestational age. Other risk factors included small for gestational age, congenital anomalies, mechanical ventilation in the first 72 hours, fraction of inhaled oxygen >0.4 in the first 72 hours, and patent ductus arteriosus. After adjusting for clinical risk factors, there was still a 4- to 5-fold difference in institutions' odds of home oxygen use.
Home oxygen use was common in infants of earlier gestational ages and infants with more severe respiratory illness. Institutional variation accounted for 4- to 5-fold variation in home oxygen use. Families should be counseled about the likelihood of home oxygen use, and prospective research must identify optimal treatment strategies for high-risk infants.
评估早产儿家庭吸氧情况，确定预测家庭吸氧的风险因素，并量化各新生儿重症监护病房（NICU）家庭吸氧的机构间差异程度。
我们对 2009 年出院回家的 23 至 31 周龄存活婴儿进行了回顾性队列分析，Pediatrix 临床数据仓库提供了去标识化的电子病历信息。混合效应逻辑回归量化了影响家庭吸氧的临床风险因素和机构间差异。
共确定了 8167 名婴儿。家庭吸氧情况因胎龄而异，23 至 24 周胎龄的婴儿中 59%需要吸氧，29 至 31 周胎龄的婴儿中仅 7%需要吸氧。其他风险因素包括小于胎龄儿、先天畸形、出生后前 72 小时内使用机械通气、前 72 小时内吸入氧分数>0.4 以及动脉导管未闭。在调整了临床风险因素后，各机构家庭吸氧的几率仍存在 4 至 5 倍的差异。
胎龄较早和患有更严重呼吸系统疾病的婴儿更常需要家庭吸氧。机构间差异导致家庭吸氧的几率存在 4 至 5 倍的差异。应向家庭提供关于家庭吸氧可能性的咨询，前瞻性研究必须确定高危婴儿的最佳治疗策略。
