Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA; California Perinatal Quality of Care Collaborative, Palo Alto, CA.
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA; California Perinatal Quality of Care Collaborative, Palo Alto, CA.
J Pediatr. 2019 Jul;210:91-98.e1. doi: 10.1016/j.jpeds.2019.03.007. Epub 2019 Apr 6.
To determine rates of at least 1 high-risk infant follow-up (HRIF) visit by 12 months corrected age, and factors associated with successful first visit among very low birth weight (VLBW) infants in a statewide population-based setting.
We used the linked California Perinatal Quality of Care Collaborative and California Perinatal Quality of Care Collaborative-California Children's Services HRIF databases. Multivariable logistic regression examined independent associations of maternal, sociodemographic, neonatal clinical, and HRIF program factors with a successful first HRIF visit among VLBW infants born in 2010-2011.
Among 6512 VLBW children referred to HRIF, 4938 (76%) attended a first visit. Higher odds for first HRIF visit attendance was associated with older maternal age (OR, 1.48; 95% CI, 1.27-1.72; 30-39 vs 20-29 years), lower birth weight (OR, 2.11; 95% CI, 1.69-2.65; ≤750 g vs 1251-1499 g), private insurance (OR, 1.65; 95% CI, 1.19-2.31), a history of severe intracranial hemorrhage (OR, 1.61; 95% CI, 1.12-2.30), 2 parents as primary caregivers (OR, 1.18, 95% CI 1.03-1.36), and higher HRIF program volume (OR, 2.62; 95% CI, 1.88-3.66; second vs lowest quartile); and lower odds with maternal race African American or black (OR, 0.65; 95% CI, 0.54-0.78), and greater distance to HRIF program (OR, 0.69; 95% CI, 0.57-0.83). Rates varied substantially across HRIF programs, which remained after risk adjustment.
In a population-based California VLBW cohort, maternal, sociodemographic, and home- and program-level disparities were associated with HRIF non-attendance. These findings underscore the need to identify challenges in access and resource risk factors during hospitalization in the neonatal intensive care unit, provide enhanced education about the benefits of HRIF, and create comprehensive neonatal intensive care unit-to-home transition approaches.
在全州范围内基于人群的研究中，确定至少有 1 次 12 个月龄校正后高风险婴儿随访（HRIF）就诊的比例，以及极低出生体重（VLBW）婴儿中与首次成功就诊相关的因素。
我们使用了加利福尼亚围产期护理质量协作组织和加利福尼亚围产期护理质量协作组织-加利福尼亚儿童服务 HRIF 数据库。多变量逻辑回归分析了产妇、社会人口统计学、新生儿临床和 HRIF 计划因素与 2010-2011 年出生的 VLBW 婴儿首次 HRIF 就诊之间的独立关联。
在转诊至 HRIF 的 6512 名 VLBW 儿童中，有 4938 名（76%）接受了首次就诊。首次 HRIF 就诊的可能性更高与母亲年龄较大（比值比 [OR]，1.48；95%置信区间 [CI]，1.27-1.72；30-39 岁与 20-29 岁）、出生体重较低（OR，2.11；95%CI，1.69-2.65；≤750 g 与 1251-1499 g）、私人保险（OR，1.65；95%CI，1.19-2.31）、严重颅内出血史（OR，1.61；95%CI，1.12-2.30）、2 位父母为主要照顾者（OR，1.18，95%CI，1.03-1.36）、HRIF 计划量较高（OR，2.62；95%CI，1.88-3.66；第二与最低四分位数）有关；而母亲为非裔美国人或黑人（OR，0.65；95%CI，0.54-0.78）和距离 HRIF 计划较远（OR，0.69；95%CI，0.57-0.83）的可能性较低。在风险调整后，HRIF 计划之间的差异仍然很大。
在加利福尼亚 VLBW 队列中，产妇、社会人口统计学以及家庭和计划层面的差异与 HRIF 就诊率低有关。这些发现强调了在新生儿重症监护病房住院期间需要确定获取服务和资源方面的挑战和风险因素，提供关于 HRIF 益处的强化教育，并制定全面的新生儿重症监护病房到家庭的过渡方法。
