Guttmann Katherine, Silverman Rachel, Weintraub Andrea S
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
BMJ Support Palliat Care. 2023 Aug 24. doi: 10.1136/spcare-2023-004305.
(1) To operationalise our previously published definition of neonatal serious illness by applying it to a patient cohort and (2) to evaluate timing of palliative care consultation, goals of care discussions and meeting serious illness criteria.
This was a retrospective chart review. Inborn neonates delivered between January 2006 and December 2020 who died prior to neonatal intensive care unit discharge were identified through EPIC query. Kruskal-Wallis and Mann-Whitney-U tests were used to compare time intervals relating to transition to serious illness across causes of death and other factors. χ tests were used to examine frequency of goals of care conversations by factors.
Eighty-eight per cent of patients met criteria for neonatal serious illness within 48 hours of life. There were no significant differences in transition to serious illness between preterm and term infants. Time to identification of serious illness varied significantly by cause of death. Palliative care was consulted for 5.7% of patients.
All patients met criteria for serious illness early in life based on our definition. This definition may be useful for identifying neonates with serious illness in time to provide support. Additional work is needed to apply this definition prospectively to explore its utility for clinical care and research.
（1）通过将我们之前发表的新生儿重症疾病定义应用于患者队列来使其可操作化，以及（2）评估姑息治疗咨询的时机、护理目标讨论情况和符合重症疾病标准的情况。
这是一项回顾性病历审查。通过EPIC查询确定了2006年1月至2020年12月期间出生且在新生儿重症监护病房出院前死亡的先天性新生儿。使用Kruskal-Wallis检验和Mann-Whitney-U检验来比较不同死亡原因和其他因素下与转变为重症疾病相关的时间间隔。使用χ检验按因素检查护理目标对话的频率。
88%的患者在出生后48小时内符合新生儿重症疾病标准。早产儿和足月儿在转变为重症疾病方面无显著差异。根据死亡原因，识别重症疾病的时间差异显著。5.7%的患者接受了姑息治疗咨询。
根据我们的定义，所有患者在生命早期均符合重症疾病标准。该定义可能有助于及时识别患有重症疾病的新生儿以提供支持。需要进一步开展工作，前瞻性地应用此定义以探索其在临床护理和研究中的效用。
