Watnick Caroline S, Binns Helen J, Greenberg Robert S
Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and Departments of Pediatrics, and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois Mary Ann and J. Milburn Smith Child Health Research Program, Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Chicago, Illinois; and.
Hosp Pediatr. 2015 Mar;5(3):119-26. doi: 10.1542/hpeds.2014-0080.
To examine effectiveness of an intervention promoting vitamin D supplementation in hospitalized breastfed infants.
Our urban tertiary care hospital instituted a 2-part intervention: brief education for providers on vitamin D guidelines and insertion of an opt-in order for vitamin D supplements into electronic admission order sets. Data downloads on admissions of patients aged <1 year were obtained. We excluded those not breastfed, with a dietary restriction, or admitted to intensive care. Intervention effects were compared from 6 months postintervention to the 6 same months 1 year earlier. We applied χ2 and logistic regression, including the patient as a random effect to adjust for repeated admissions.
Data on 471 exclusively or partially breastfed admissions (441 infants) were analyzed (221 preintervention, 250 postintervention). Admission characteristics did not differ by period: 55.0% boys; 40.6% Medicaid; 63.7% hospitalized ≤2 days; 72.0% on a general medical service; 16.6% received nutritionist consultation. In-hospital vitamin D prescribing rates significantly increased postintervention (19.5% vs 44.4%; P<.001). Postintervention admissions were more than twice as likely to receive vitamin D supplementation (adjusted odds ratio 2.3, 95% confidence interval 1.6-3.2). Other associated factors included vitamin D as a medication used before admission (adjusted odds ratio 14.3, 95% confidence interval 4.9-41.6), nutritionist consultation during admission, hospitalization≥3 days, and admission to a general medical service. Prescribing of vitamin D at discharge increased significantly (9.0% vs 19.6%; P<.001).
Medical provider education and modification of electronic ordering templates significantly increased use of vitamin D supplementation in hospitalized breastfed infants.
探讨促进住院母乳喂养婴儿补充维生素D的干预措施的有效性。
我们的城市三级医疗中心实施了一项分为两部分的干预措施：对医护人员进行维生素D指南的简短培训，并在电子入院医嘱集中添加维生素D补充剂的选择加入医嘱。获取了年龄<1岁患者入院情况的数据下载。我们排除了非母乳喂养、有饮食限制或入住重症监护病房的患者。将干预后6个月与前一年同期的6个月进行干预效果比较。我们应用卡方检验和逻辑回归分析，将患者作为随机效应纳入以调整重复入院情况。
分析了471例纯母乳喂养或部分母乳喂养入院患者（441名婴儿）的数据（干预前221例，干预后250例）。不同时期的入院特征无差异：55.0%为男孩；40.6%接受医疗补助；63.7%住院≤2天；72.0%在普通内科病房；16.6%接受了营养师咨询。干预后住院期间维生素D的处方率显著提高（19.5%对44.4%；P<.001）。干预后入院患者接受维生素D补充剂的可能性是干预前的两倍多（调整后的优势比为2.3，95%置信区间为1.6 - 3.2）。其他相关因素包括入院前使用过维生素D作为药物（调整后的优势比为14.3，95%置信区间为4.9 - 41.6）、住院期间接受营养师咨询、住院≥3天以及入住普通内科病房。出院时维生素D的处方率显著增加（9.0%对19.6%；P<.001）。
对医护人员的教育和电子医嘱模板的修改显著增加了住院母乳喂养婴儿维生素D补充剂的使用。
