Murthy K, Porta N F M, Lagatta J M, Zaniletti I, Truog W E, Grover T R, Nelin L D, Savani R C
Department of Pediatrics, Feinberg School of Medicine, Northwestern University and The Ann &Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Department of Pediatrics, Medical College of Wisconsin and The Children's Hospital of Wisconsin, Milwaukee, WI, USA.
J Perinatol. 2017 Jun;37(6):723-727. doi: 10.1038/jp.2016.277. Epub 2017 Feb 9.
To estimate the presence and sources of inter-center variation (ICV) in the risk of death or tracheostomy placement (D/T) among infants with severe bronchopulmonary dysplasia (sBPD)Study design:We analyzed the Children's Hospitals Neonatal Database between 2010 and 2013 to identify referred infants born <32 weeks' gestation with sBPD. The association between center and the primary outcome of D/T was analyzed by multivariable modeling. Hypothesized diagnoses/practices were included to determine if these explained any observed ICV in D/T.
D/T occurred in 280 (20%) of 1383 eligible infants from 21 centers. ICV was significant for D/T (range 2-46% by center, P<0.001) and tracheostomy placement (n=187, range 2-37%, P<0.001), but not death (n=93, range 0-19%, P=0.08). This association persisted in multivariable analysis (adjusted center-specific odds ratios for D/T varied 5.5-fold, P=0.009).
ICV in D/T is apparent among infants with sBPD. These results highlight that the indications for tracheostomy (and subsequent chronic ventilation) remain uncertain.
评估重度支气管肺发育不良（sBPD）婴儿死亡或气管造口术（D/T）风险的中心间差异（ICV）及其来源。
我们分析了2010年至2013年儿童医院新生儿数据库，以确定孕周<32周且患有sBPD的转诊婴儿。通过多变量建模分析中心与D/T主要结局之间的关联。纳入假设的诊断/做法以确定它们是否解释了D/T中观察到的任何ICV。
来自21个中心的1383名符合条件的婴儿中有280名（20%）发生了D/T。D/T的ICV具有显著性（各中心范围为2%-46%，P<0.001），气管造口术的ICV也具有显著性（n = 187，范围为2%-37%，P<0.001），但死亡的ICV不具有显著性（n = 93，范围为0%-19%，P = 0.08）。这种关联在多变量分析中持续存在（D/T的调整后中心特异性比值比变化了5.5倍，P = 0.009）。
sBPD婴儿中D/T的ICV明显。这些结果突出表明气管造口术（以及随后的长期通气）的指征仍然不确定。
