Department of Neonatology, OLVG, Amsterdam, The Netherlands.
Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands.
Pediatr Res. 2020 Oct;88(4):593-600. doi: 10.1038/s41390-020-0875-9. Epub 2020 Apr 2.
During hospital stay after birth, preterm infants are susceptible to late-onset sepsis (LOS).
To study the effect of family integrated care in single family rooms (SFRs) compared to standard care in open bay units (OBUs) on LOS. Peripheral or central venous catheters (PVCs/CVCs) and parenteral nutrition (PN) were investigated as potential mediators. Secondary outcomes were length of stay, exclusive breastfeeding at discharge, and weight gain during hospital stay.
Single-center retrospective before-after study with preterm infants admitted ≥3 days.
We studied 1,046 infants (468 in SFRs, 578 in OBUs, median gestational age 35 weeks). SFRs were associated with less LOS (adjusted odds ratio (OR) 0.486, 95% confidence interval (CI): 0.293; 0.807, p = 0.005). PVCs (indirect effect -1.757, 95% CI: -2.738; -1.068), CVCs (indirect effect -1.002, 95% CI: -2.481; 0.092), and PN (indirect effect -1.784, 95% CI: -2.688; -1.114) were possible mediators of the effect. PN was the main mediator of the effect of SFRs on LOS. We found shorter length of stay (median length of stay in SFRs 10 days and in OBUs 12 days, adjusted β -0.088, 95% CI: -0.159; -0.016, p = 0.016), but no differences in weight gain or exclusive breastfeeding at discharge.
SFRs were associated with decreased incidences of LOS and shorter length of hospital stay. The positive effect of SFRs on LOS was mainly mediated through a decreased use of PN in SFRs.
Family integrated care (FICare) in single family rooms for preterm infants was associated with less late-onset sepsis events during hospital stay and a shorter length of hospital stay after birth. FICare in single family rooms was associated with less use of peripheral or central venous catheters and parenteral nutrition. Mediation analysis provided insights into the mechanisms underlying the effect of FICare in single family rooms on late-onset sepsis and helped explain the differences observed in late-onset sepsis between FICare in single family rooms and open bay units. The reduction in late-onset sepsis in FICare in single family rooms was mediated by a reduced use of intravenous catheters and parenteral nutrition.
早产儿在出生后的住院期间易发生晚发性败血症（LOS）。
研究家庭一体化护理在单人间（SFR）与开放式婴儿床单元（OBU）中的标准护理相比，对 LOS 的影响。外周或中心静脉导管（PVC/CVC）和肠外营养（PN）被作为潜在的中介因素进行研究。次要结果为住院时间、出院时纯母乳喂养和住院期间体重增加。
单中心回顾性前后对照研究，纳入至少住院 3 天的早产儿。
我们研究了 1046 名婴儿（SFR 组 468 名，OBU 组 578 名，中位胎龄 35 周）。SFR 与 LOS 减少相关（调整后的优势比（OR）0.486，95%置信区间（CI）：0.293；0.807，p=0.005）。PVC（间接效应-1.757，95%CI：-2.738；-1.068）、CVC（间接效应-1.002，95%CI：-2.481；0.092）和 PN（间接效应-1.784，95%CI：-2.688；-1.114）可能是 SFR 对 LOS 影响的中介因素。PN 是 SFR 对 LOS 影响的主要中介因素。我们发现住院时间更短（SFR 组的中位住院时间为 10 天，OBU 组为 12 天，调整后的β为-0.088，95%CI：-0.159；-0.016，p=0.016），但在出院时体重增加或纯母乳喂养方面没有差异。
SFR 与 LOS 发生率降低和住院时间缩短有关。SFR 对 LOS 的积极影响主要通过减少 SFR 中 PN 的使用来介导。
家庭一体化护理（FICare）在单人间中对早产儿的护理与住院期间晚发性败血症事件的减少和出生后住院时间的缩短有关。单人间中的 FICare 与外周或中心静脉导管和肠外营养的使用减少有关。中介分析提供了对家庭一体化护理单人间对晚发性败血症影响机制的深入了解，并解释了单人间与开放式婴儿床单元之间晚发性败血症差异的原因。家庭一体化护理单人间中晚发性败血症的减少是通过减少静脉导管和肠外营养的使用来介导的。
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