Montenegro Brian L, Amberson Michael, Veit Lauren, Freiberger Christina, Dukhovny Dmitry, Rhein Lawrence M
Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts.
Boston University School of Medicine, Boston, Massachusetts.
Respir Care. 2017 Jan;62(1):42-48. doi: 10.4187/respcare.04954.
Apnea of prematurity affects a small proportion but large absolute number of late preterm infants, with out-patient management variably utilized despite relative clinical equipoise and potential for improved cost-effectiveness.
Over a 5-y period, from 2009 to 2013, infants born at ≥34 weeks gestational age at a level IIIB academic center in Boston, Massachusetts, with discharge-delaying apnea, bradycardia, and desaturation (ABD) events were identified. In-patient costs for discharge-delaying ABD events were compared with hypothetical out-patient management. Out-patient costs took into account 4-10 d of in-patient observation for ABD events before caffeine initiation, 3-5 d of additional in-patient observation before discharge, daily caffeine until 43 weeks corrected gestational age, home pulse oximetry monitoring until 44 weeks corrected gestational age, and consideration of variable readmission rates ranging from 0 to 10%.
A total of 425 late preterm and term infants were included in our analysis. Utilization of hypothetical out-patient management resulted in cost savings per eligible patient ranging from $2,422 to $62, dependent upon variable periods of in-patient observation. Sensitivity analysis demonstrated few instances of decreased relative cost-effectiveness.
Out-patient management of discharge-delaying ABD events in a late preterm and term population was a cost-effective alternative to prolonged in-patient observation.
早产呼吸暂停影响的晚期早产儿比例虽小，但绝对数量较大，尽管临床存在相对平衡且有可能提高成本效益，但门诊管理的使用情况各不相同。
在2009年至2013年的5年期间，确定了在马萨诸塞州波士顿一家三级学术中心出生、胎龄≥34周且有出院延迟性呼吸暂停、心动过缓和血氧饱和度下降（ABD）事件的婴儿。将出院延迟性ABD事件的住院费用与假设的门诊管理费用进行比较。门诊费用考虑了在开始使用咖啡因前对ABD事件进行4至10天的住院观察、出院前额外3至5天的住院观察、直至矫正胎龄43周的每日咖啡因治疗、直至矫正胎龄44周的家庭脉搏血氧饱和度监测，以及0%至10%不等的可变再入院率。
我们的分析共纳入了425名晚期早产儿和足月儿。假设的门诊管理的使用使每名符合条件的患者节省的费用在62美元至2422美元之间，这取决于住院观察的不同时长。敏感性分析显示，相对成本效益降低的情况很少。
对晚期早产儿和足月儿群体中出院延迟性ABD事件进行门诊管理是延长住院观察的一种具有成本效益的替代方案。
