Department of Pediatrics, Maclean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL 60637, USA.
Acta Paediatr. 2012 Apr;101(4):397-402. doi: 10.1111/j.1651-2227.2011.02555.x. Epub 2012 Jan 10.
To quantify the cost and prediction of futile care in the Neonatal Intensive Care Unit (NICU).
We observed 1813 infants on 100,000 NICU bed days between 1999 and 2008 at the University of Chicago. We determined costs and assessed predictions of futility for each day the infant required mechanical ventilation.
Only 6% of NICU expenses were spent on nonsurvivors, and in this sense, they were futile. If only money spent after predictions of death is considered, futile expenses fell to 4.5%. NICU care was preferentially directed to survivors for even the smallest infants, at the highest risk to die. Over 75% of ventilated NICU infants were correctly predicted to survive on every day of ventilation by every caretaker. However, predictions of 'die before discharge' were wrong more than one time in three. Attendings and neonatology fellows tended to be optimistic, while nurses and neonatal nurse practitioners tended to be pessimistic.
Criticisms of the expense of NICU care find little support in these data. Rather, NICU care is remarkably well targeted to patients who will survive, particularly when contrasted with care in adult ICUs. We continue to search for better prognostic tools for individual infants.
量化新生儿重症监护病房（NICU）中无效治疗的成本和预测。
我们观察了 1999 年至 2008 年期间在芝加哥大学的 100000 个 NICU 床位日中的 1813 名婴儿。我们确定了每个需要机械通气的婴儿的成本，并评估了无效治疗的预测。
NICU 费用的仅 6%用于非幸存者，从这个意义上说，这些费用是无效的。如果仅考虑死亡预测后的支出，则无效费用下降到 4.5%。即使是风险最高的最小婴儿，NICU 护理也优先针对幸存者。超过 75%的通气 NICU 婴儿在每个通气日都被每个护理人员正确预测为存活。然而，“在出院前死亡”的预测错误超过三分之一。主治医生和新生儿科研究员往往比较乐观，而护士和新生儿执业护师则比较悲观。
这些数据对 NICU 护理费用的批评没有得到多少支持。相反，NICU 护理非常针对那些将存活的患者，特别是与成人 ICU 中的护理相比。我们继续为个别婴儿寻找更好的预后工具。
