Mendoza T Luis Alfonso, Arias G Martha, Osorio R Miguel Ángel
Rev Chil Pediatr. 2014 Apr;85(2):164-73. doi: 10.4067/S0370-41062014000200005.
To evaluate factors present on newborn admission to a neonatal intensive care and associated with a prolonged hospital stay.
Non-matched case-control study, with 555 infants, 111 with more than 7 days of hospital stay and 444 who stayed hospitalized between 1 and 7 days, between 2005 and 2010. Pre hospitalization maternal factors (age, pregnancy, health insurance, education, prenatal care, marital status, history of preeclampsia, prolonged rupture of membranes, chorioamnionitis infection) and neonatal ones (age at admission, gestational age, birth weight, gender, delivery practice, route of admission, Apgar and type of resuscitation) that were associated with prolonged hospital stay were analyzed. Analyses were conducted using STATA 11.0 and logistic regression in the multivariate analysis.
Maternal factors such as prenatal care with less than 5 doctor visits (AOR 2.7, 95% CI 1.3-5.5), lack of social health insurance (AOR 1.9, 95% CI 1.4-29), pregnant three or more times (AOR 1.7, 95% CI 1.1-2.7), neonatal birth weight under 2,000 g (AOR 4.2, 95% CI 1.9-9.5), need for cardiopulmonary resuscitation (AOR 4.2, 95% CI 2-9.1), gestational age less than 36 weeks (AOR 3.9, 95% CI 2-7.7) and admission to the neonatal unit through emergency room or referral from another hospital (AOR 2.8, 95% CI 1.7-4.6) were associated with hospital stays longer than 7 days.
In-hospital complications that affect a prolonged stay at the health center were social health insurance, maternal education and prenatal care, and these should be considered in the evaluation of the hospital care quality indicators.
评估新生儿入住新生儿重症监护病房时存在的、与住院时间延长相关的因素。
2005年至2010年间进行的非匹配病例对照研究,涉及555名婴儿,其中111名住院时间超过7天,444名住院时间在1至7天之间。分析了与住院时间延长相关的入院前母体因素(年龄、妊娠情况、医疗保险、教育程度、产前护理、婚姻状况、先兆子痫病史、胎膜早破、绒毛膜羊膜炎感染)和新生儿因素(入院时年龄、胎龄、出生体重、性别、分娩方式、入院途径、阿氏评分及复苏类型)。使用STATA 11.0进行分析,并在多变量分析中采用逻辑回归。
母体因素如产前检查就诊次数少于5次(比值比2.7,95%置信区间1.3 - 5.5)、缺乏社会医疗保险(比值比1.9,95%置信区间1.4 - 2.9)、怀孕三次或更多次(比值比1.7,95%置信区间1.1 - 2.7)、新生儿出生体重低于2000克(比值比4.2,95%置信区间1.9 - 9.5)、需要心肺复苏(比值比4.2,95%置信区间2 - 9.1)、胎龄小于36周(比值比3.9,95%置信区间2 - 7.7)以及通过急诊室或从其他医院转诊进入新生儿病房(比值比2.8,95%置信区间1.7 - 4.6)与住院时间超过7天相关。
影响在健康中心长时间住院的院内并发症包括社会医疗保险、母体教育程度和产前护理,在评估医院护理质量指标时应予以考虑。