Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany.
Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.
Pediatr Crit Care Med. 2018 Dec;19(12):1153-1161. doi: 10.1097/PCC.0000000000001756.
To compare duration and changes over time in length of hospital stay for very preterm and extremely preterm infants in 10 European regions.
Two area-based cohort studies from the same regions in 2003 and 2011/2012.
Ten regions from nine European countries.
Infants born between 22 + 0 and 31 + 6 weeks of gestational age and surviving to discharge (Models of Organising Access to Intensive Care for Very Preterm Births cohort in 2003, n = 4,011 and Effective Perinatal Intensive Care in Europe cohort in 2011/2012, n = 4,336).
Observational study, no intervention.
Maternal and infant characteristics were abstracted from medical records using a common protocol and length of stay until discharge was adjusted for case-mix using negative binomial regression. Mean length of stay was 63.6 days in 2003 and varied from 52.4 to 76.5 days across regions. In 2011/2012, mean length of stay was 63.1 days, with a narrower regional range (54.0-70.1). Low gestational age, small for gestational age, low 5-minute Apgar score, surfactant administration, any surgery, and severe neonatal morbidities increased length of stay. Infant characteristics explained some of the differences between regions and over time, but large variations remained after adjustment. In 2011/2012, mean adjusted length of stay ranged from less than 54 days in the Northern region of the United Kingdom and Wielkopolska, Poland to over 67 days in the Ile-de-France region of France and the Eastern region of the Netherlands. No systematic decrease in very preterm length of stay was observed over time after adjustment for patient case-mix.
A better understanding of the discharge criteria and care practices that contribute to the wide differences in very preterm length of stay across European regions could inform policies to optimize discharge decisions in terms of infant outcomes and health system costs.
比较欧洲 10 个地区非常早产和极早产婴儿的住院时间长短及其随时间的变化。
来自 2003 年和 2011/2012 年同一地区的两项基于区域的队列研究。
来自 9 个欧洲国家的 10 个地区。
出生胎龄为 22+0 至 31+6 周且存活至出院的婴儿（2003 年的新生儿重症监护组织模式队列，n=4011 和 2011/2012 年的欧洲有效围产期重症监护队列，n=4336）。
观察性研究，无干预措施。
使用统一方案从病历中提取母婴特征，并使用负二项回归调整病例组合，以调整至出院的住院时间。2003 年平均住院时间为 63.6 天，各地区住院时间从 52.4 天至 76.5 天不等。2011/2012 年，平均住院时间为 63.1 天，地区范围较窄（54.0-70.1）。低胎龄、小于胎龄、5 分钟 Apgar 评分低、表面活性剂给药、任何手术和严重新生儿并发症均会延长住院时间。婴儿特征解释了部分地区间和随时间的差异，但调整后仍存在较大差异。2011/2012 年，在英国北部和波兰大波兰省，平均调整后住院时间不到 54 天，而在法国法兰西岛大区和荷兰东部地区，平均调整后住院时间超过 67 天。调整患者病例组合后，未观察到非常早产住院时间随时间的系统减少。
更好地了解导致欧洲各地区非常早产住院时间差异的出院标准和护理实践，可为优化出院决策提供信息，以改善婴儿结局和卫生系统成本。
