Lee K S, Perlman M, Ballantyne M, Elliott I, To T
Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr. 1995 Nov;127(5):758-66. doi: 10.1016/s0022-3476(95)70170-2.
A recent rapid decrease in the duration of neonatal hospital stay in Ontario, Canada, enabled us to study the association between healthy infants' age at neonatal hospital discharge and subsequent readmission rates.
(1) Population-based and (2) single hospital-based retrospective studies.
(1) A total of 920,554 healthy infants with a birth weight of 2500 gm or more, born in Ontario from 1987 to 1994. (2) Infants with a birth weight of 2500 gm or more, born during the same period, and readmitted before 15 days from home to the Hospital for Sick Children for jaundice or dehydration.
Duration of neonatal stay in the hospital and readmission rates were measured, and diagnostic codes were analyzed. Severity of illness was evaluated in infants readmitted to our hospital.
In Ontario the mean length of stay decreased from 4.5 days to 2.7 days (p = 0.000), and the readmission rate during the first 2 weeks of life increased from 12.9 to 20.7 per 1000 (p = 0.000). Increased rates of readmission were most marked for jaundice and dehydration. The infants readmitted to our hospital had evidence of increased severity of illness as indicated by higher serum bilirubin and sodium concentrations. Two deaths occurred in infants with hypernatremic dehydration, one in 1992-1993 and another in 1993-1994.
In Ontario, shorter neonatal hospital stay was associated with increased readmission rates for conditions that may not give rise to symptoms or signs on days 1 to 3 of life. In our hospital the severity of jaundice and dehydration in readmitted infants increased. The severity-of-illness data raise the question of whether shorter neonatal hospital stay of apparently healthy infants is always safe. Decisions to discharge infants should be based on rigorous evaluation of individual infants.
加拿大安大略省新生儿住院时间近期迅速缩短，这使我们能够研究健康婴儿新生儿出院时的年龄与随后再入院率之间的关联。
（1）基于人群的研究和（2）基于单一医院的回顾性研究。
（1）1987年至1994年在安大略省出生的920554名出生体重2500克或以上的健康婴儿。（2）同期出生、出生体重2500克或以上、在家中15天内因黄疸或脱水再次入住病童医院的婴儿。
测量新生儿住院时间和再入院率，并分析诊断编码。对再次入住我院的婴儿评估疾病严重程度。
在安大略省，平均住院时间从4.5天降至2.7天（p = 0.000），出生后头2周的再入院率从每1000例中的12.9例增至20.7例（p = 0.000）。黄疸和脱水的再入院率上升最为显著。再次入住我院的婴儿有疾病严重程度增加的证据，表现为血清胆红素和钠浓度升高。1992 - 1993年和1993 - 1994年各有1例高钠血症脱水婴儿死亡。
在安大略省，新生儿住院时间缩短与出生后第1至3天可能未出现症状或体征的疾病再入院率增加有关。在我院，再次入院婴儿的黄疸和脱水严重程度增加。疾病严重程度数据引发了一个问题，即表面健康的婴儿新生儿住院时间缩短是否总是安全的。婴儿出院决策应基于对个体婴儿的严格评估。
