Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35249-7335, USA.
Pediatrics. 2011 Nov;128(5):e1216-25. doi: 10.1542/peds.2011-1142. Epub 2011 Oct 17.
Extremely low birth weight infants often require rehospitalization during infancy. Our objective was to identify at the time of discharge which extremely low birth weight infants are at higher risk for rehospitalization.
Data from extremely low birth weight infants in Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers from 2002-2005 were analyzed. The primary outcome was rehospitalization by the 18- to 22-month follow-up, and secondary outcome was rehospitalization for respiratory causes in the first year. Using variables and odds ratios identified by stepwise logistic regression, scoring systems were developed with scores proportional to odds ratios. Classification and regression-tree analysis was performed by recursive partitioning and automatic selection of optimal cutoff points of variables.
A total of 3787 infants were evaluated (mean ± SD birth weight: 787 ± 136 g; gestational age: 26 ± 2 weeks; 48% male, 42% black). Forty-five percent of the infants were rehospitalized by 18 to 22 months; 14.7% were rehospitalized for respiratory causes in the first year. Both regression models (area under the curve: 0.63) and classification and regression-tree models (mean misclassification rate: 40%-42%) were moderately accurate. Predictors for the primary outcome by regression were shunt surgery for hydrocephalus, hospital stay of >120 days for pulmonary reasons, necrotizing enterocolitis stage II or higher or spontaneous gastrointestinal perforation, higher fraction of inspired oxygen at 36 weeks, and male gender. By classification and regression-tree analysis, infants with hospital stays of >120 days for pulmonary reasons had a 66% rehospitalization rate compared with 42% without such a stay.
The scoring systems and classification and regression-tree analysis models identified infants at higher risk of rehospitalization and might assist planning for care after discharge.
极低出生体重儿在婴儿期常需再次住院。本研究旨在确定出院时哪些极低出生体重儿有更高的再住院风险。
对 Eunice Kennedy Shriver 国家儿童健康与人类发展研究所新生儿研究网络中心 2002-2005 年极低出生体重儿的数据进行分析。主要结局为 18-22 个月时的再住院，次要结局为第 1 年因呼吸系统疾病的再住院。采用逐步逻辑回归确定的变量和比值比，建立得分系统，得分与比值比成正比。通过递归分区和变量最佳截断点的自动选择进行分类和回归树分析。
共评估了 3787 例婴儿（平均±标准差出生体重：787±136 g；胎龄：26±2 周；48%为男性，42%为黑人）。45%的婴儿在 18-22 个月时再次住院；14.7%在第 1 年因呼吸系统疾病再次住院。回归模型（曲线下面积：0.63）和分类与回归树模型（平均错误分类率：40%-42%）均具有中等准确性。回归模型预测主要结局的指标包括脑积水分流手术、因肺部疾病住院时间＞120 天、坏死性小肠结肠炎Ⅱ级或更高级别或自发性胃肠穿孔、36 周时吸入氧分数较高、男性。通过分类和回归树分析，因肺部疾病住院时间＞120 天的婴儿再住院率为 66%，而无此住院史的婴儿再住院率为 42%。
评分系统和分类与回归树分析模型可识别再住院风险较高的婴儿，并可能有助于规划出院后的护理。
