Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT.
Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Stanford University School of Medicine, Stanford, CA.
J Pediatr. 2018 Dec;203:225-233.e1. doi: 10.1016/j.jpeds.2018.07.025. Epub 2018 Sep 20.
To test the hypothesis that neonatal intensive care unit (NICU)-specific changes in patent ductus arteriosus (PDA) management are associated with changes in local outcomes in preterm infants.
This retrospective repeated-measures study of aggregated data included infants born 400-1499 g admitted within 2 days of delivery to NICUs participating in the California Perinatal Quality Care Collaborative. The period 2008-2015 was divided into four 2-year epochs. For each epoch and NICU, we calculated proportions of infants receiving cyclooxygenase inhibitor (COXI) or PDA ligation and determined NICU-specific changes in these therapies between consecutive epochs. Generalized estimating equations were used to examine adjusted relationships between NICU-specific changes in PDA management and contemporaneous changes in local outcomes.
We included 642 observations of interepoch change at 119 hospitals summarizing 32 094 infants. NICU-specific changes in COXI use and ligation showed significant dose-response associations with contemporaneous changes in adjusted local outcomes. Each percentage point decrease in NICU-specific proportion treated with either COXI or ligation was associated with a 0.21 percentage point contemporaneous increase in adjusted local in-hospital mortality (95% CI 0.06, 0.33; P = .005) among infants born 400-749 g. In contrast, decreasing NICU-specific ligation rate among infants 1000-1499 g was associated with decreasing adjusted local bronchopulmonary dysplasia (P = .009) and death or bronchopulmonary dysplasia (P = .01).
NICU-specific outcomes of preterm birth co-vary with local PDA management. Treatment for PDA closure may benefit some infants born 400-749 g. Decreasing NICU-specific rates of COXI use or ligation were not associated with increases in local adjusted rates of examined adverse outcomes in larger preterm infants.
检验以下假设，即新生儿重症监护病房（NICU）特有的动脉导管未闭（PDA）管理变化与早产儿局部结局变化相关。
本研究为回顾性重复测量研究，使用了加利福尼亚围产期质量协作组织（California Perinatal Quality Care Collaborative）参与单位的聚合数据，纳入了出生体重为 400-1499 克、生后 2 天内入住 NICU 的婴儿。将 2008-2015 年分为四个 2 年时期。对于每个时期和 NICU，我们计算了接受环氧化酶抑制剂（COXI）或 PDA 结扎治疗的婴儿比例，并确定了连续时期之间这些治疗方法的 NICU 特异性变化。使用广义估计方程来检验 PDA 管理的 NICU 特异性变化与同期局部结局变化之间的调整关系。
我们纳入了 119 家医院的 642 次时期间变化观察结果，汇总了 32094 名婴儿。COXI 使用和结扎的 NICU 特异性变化与同期调整后局部结局变化呈显著剂量反应关系。NICU 特异性治疗比例每降低 1%，出生体重为 400-749 克的婴儿同期调整后局部院内死亡率就会增加 0.21%（95%CI 0.06，0.33；P=0.005）。相比之下，1000-1499 克出生体重的婴儿中，NICU 特异性结扎率下降与调整后局部支气管肺发育不良（P=0.009）和死亡或支气管肺发育不良（P=0.01）发生率降低有关。
NICU 特异性早产结局与局部 PDA 管理相关。对于出生体重为 400-749 克的婴儿，治疗 PDA 闭合可能有益。在较大早产儿中，降低 NICU 特异性 COXI 使用或结扎率与局部调整不良结局发生率增加无关。
