Fein Eric Herschel, Friedlander Scott, Lu Yang, Pak Youngju, Sakai-Bizmark Rie, Smith Lynne M, Chantry Caroline J, Chung Paul J
Harbor-University of California Los Angeles Medical Center, Torrance, California;
Los Angeles Biomedical Research Institute, Torrance, California.
Hosp Pediatr. 2019 Feb;9(2):115-120. doi: 10.1542/hpeds.2018-0136. Epub 2019 Jan 3.
Newborns hospitalized with unconjugated hyperbilirubinemia without critical comorbidities may receive intensive phototherapy (IP) in non-ICU levels of care, such as a mother-newborn unit, or ICU levels of care. Our aim was to compare outcomes between each level.
Using hospital discharge data from 2005 to 2011 in New York's State Inpatient Database, we performed multivariate analyses to compare outcomes that included total cost of hospitalization, length of stay, 30-day readmission rate after IP, and the number of cases of death, exchange transfusion, and γ globulin infusion. We included term newborns treated with IP in their first 30 days of life and without diagnosis codes for other critical illnesses. Explanatory variables included level of care, sex, race, insurance type, presence or absence of hemolysis, hospital, volume of IP performed at each hospital, and year of hospitalization.
Ninety-nine percent of IP was delivered in non-ICU levels of care. Incidence of major complications was rare (≤0.1%). After adjusting for confounders, ICU level of care was not associated with difference in length of stay (relative risk: 1.2; 95% confidence interval [CI]: 0.91 to 1.15) or 30-day readmission rate (odds ratio: 0.74; 95% CI: 0.50 to 1.09) but was associated with 1.51 (95% CI: 1.47 to 1.56) times higher costs.
For otherwise healthy term newborns with jaundice requiring IP, most received treatment in a non-ICU level of care, and those in intensive care had no difference in outcomes but incurred higher costs. IP guideline authors may want to be more prescriptive about IP level of care to improve value.
因非结合性高胆红素血症住院且无严重合并症的新生儿，可能在母婴病房等非重症监护病房（ICU）护理级别接受强化光疗（IP），也可能在ICU护理级别接受治疗。我们的目的是比较不同护理级别之间的治疗结果。
利用纽约州住院患者数据库中2005年至2011年的医院出院数据，我们进行了多变量分析，以比较包括住院总费用、住院时间、IP治疗后30天再入院率以及死亡、换血治疗和γ球蛋白输注病例数等治疗结果。我们纳入了出生后前30天接受IP治疗且无其他严重疾病诊断编码的足月儿。解释变量包括护理级别、性别、种族、保险类型、是否存在溶血、医院、各医院IP治疗量以及住院年份。
99%的IP治疗是在非ICU护理级别进行的。主要并发症的发生率很低（≤0.1%）。在对混杂因素进行调整后，ICU护理级别与住院时间差异（相对风险：1.2；95%置信区间[CI]：0.91至1.15）或30天再入院率（优势比：0.74；95%CI：0.50至1.09）无关，但与费用高出1.51倍（95%CI：1.47至1.56）有关。
对于其他方面健康但因黄疸需要IP治疗的足月儿，大多数在非ICU护理级别接受治疗，重症监护中的患儿在治疗结果上没有差异，但费用更高。IP指南制定者可能需要对IP护理级别做出更具指导性的规定，以提高价值。
