Hatch L Dupree, Grubb Peter H, Markham Melinda H, Scott Theresa A, Walsh William F, Slaughter James C, Stark Ann R, Ely E Wesley
Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Am J Perinatol. 2017 Oct;34(12):1234-1240. doi: 10.1055/s-0037-1603341. Epub 2017 May 11.
To quantify the daily risk of unplanned extubation (UE) in newborns based on developmental and anatomical factors.
Prospective cohort of ventilated newborns over an 18-month period in a level IV neonatal intensive care unit (NICU). We captured UEs through four data streams. We generated multivariable logistic regression models to assess the association of UE with chronological age, birth weight, and postmenstrual age.
During the study, 718 infants were ventilated for 5,611 patient days with 117 UEs in 81 infants. The daily risk of UE had a significant, nonlinear relationship (p < 0.01) with chronological age, decreasing until day 7 (odds ratio [OR]: 0.5; 95% confidence interval [CI]: 0.17–1.47) and increasing after day 7 (day 7–28, OR: 1.36, 95% CI: 1.06–1.75; and >28 days, OR: 1.06, 95% CI: 1.0–1.14). Birth weight and postmenstrual age were not associated with UE. Adverse events occurred in 83/117 (71%) UE events. Iatrogenic causes of UE were more common in younger, smaller infants, whereas older, larger infants were more likely to self-extubate.
The daily risk and causes of UE change over the course of an infant’s NICU hospitalization. These data can be used to identify infants at the highest risk of UE for whom targeted proactive interventions can be developed.
基于发育和解剖因素量化新生儿非计划拔管（UE）的每日风险。
在一家四级新生儿重症监护病房（NICU）对通气的新生儿进行为期18个月的前瞻性队列研究。我们通过四个数据流捕获非计划拔管事件。我们生成多变量逻辑回归模型以评估非计划拔管与实足年龄、出生体重和孕龄的关联。
在研究期间，718名婴儿接受通气治疗5611个患者日，81名婴儿发生117次非计划拔管事件。非计划拔管的每日风险与实足年龄呈显著的非线性关系（p < 0.01），至第7天风险降低（优势比[OR]：0.5；95%置信区间[CI]：0.17 - 1.47），第7天后风险增加（第7 - 28天，OR：1.36，95%CI：1.06 - 1.75；>28天，OR：1.06，95%CI：1.0 - 1.14）。出生体重和孕龄与非计划拔管无关。83/117（71%）次非计划拔管事件发生了不良事件。非计划拔管的医源性原因在年龄较小、体重较轻的婴儿中更常见，而年龄较大、体重较重的婴儿更可能自行拔管。
婴儿在NICU住院期间非计划拔管的每日风险和原因会发生变化。这些数据可用于识别非计划拔管风险最高的婴儿，从而制定有针对性的积极干预措施。
