Beebe S A, Britton J R, Britton H L, Fan P, Jepson B
Department of Pediatrics, University of Utah, Salt Lake City 84132, USA.
Pediatrics. 1996 Aug;98(2 Pt 1):231-5.
To investigate the effect of hospital discharge time on neonatal mortality of term newborns.
Infants who were discharged home at 5 days of age of younger and who subsequently died were compared with control infants using a retrospective case-control design. Descriptive information was collected from records of infants who were not discharged home from the hospital of birth (because of death or transfer to a tertiary care hospital) to determine the age at which their illnesses presented.
We reviewed death certificates for all infants with birth weights of 2500 g or greater born at 37 weeks' gestational age or greater who died in the first 28 days of life and who were born in one of four Utah counties (1985 through 1989). Of the 109,256 eligible births, 115 infants were found who had died in the neonatal period. Eighty-four infants had not been discharged home from the hospital of birth, 5 infants had had hospital stays of more than 5 days, 9 records could not be located, 17 presumed healthy infants were discharged from the hospital at 5 days of age or younger. These 17 infants were each matched with 3 control infants. Newborn nursery charts were reviewed to determine hospital discharge times for case and control infants. Descriptive information regarding the time of presentation of illness was collected for the other 89 infants.
The mean age of hospital discharge was 43 +/- 21 hours for the 17 case infants and 47 +/- 25 hours for the 51 control infants. The odds ratio for neonatal mortality for discharge at less than 24 hours was 1.65 (95% confidence interval, 0.42 to 3.34) and for discharge at less than 48 hours was 1.16 (95% confidence interval, 0.4 to 3.34). Of the 84 infants who were not discharged home from the hospital of birth, 93% had been symptomatic by 12 hours of age, and 99% were symptomatic by 18 hours.
Most full-term infants who die in the neonatal period are symptomatic within the first 18 hours after birth. We could not demonstrate an association between early hospital discharge and neonatal mortality in those infants who died after discharge home.
探讨出院时间对足月儿新生儿死亡率的影响。
采用回顾性病例对照设计，将5日龄及以下出院回家后死亡的婴儿与对照婴儿进行比较。从未从出生医院出院回家的婴儿（因死亡或转至三级护理医院）的记录中收集描述性信息，以确定其发病年龄。
我们查阅了1985年至1989年在犹他州四个县之一出生的所有出生体重2500克或以上、孕37周或以上、在出生后28天内死亡的婴儿的死亡证明。在109256例符合条件的出生婴儿中，发现115例在新生儿期死亡。84例婴儿未从出生医院出院回家，5例婴儿住院时间超过5天，9份记录无法找到，17例推测健康的婴儿在5日龄及以下出院。这17例婴儿每例与3例对照婴儿匹配。查阅新生儿病房图表以确定病例组和对照组婴儿的出院时间。为另外89例婴儿收集了有关发病时间的描述性信息。
17例病例组婴儿的平均出院年龄为43±21小时，51例对照组婴儿为47±25小时。24小时内出院的新生儿死亡比值比为1.65（95%可信区间，0.42至3.34），48小时内出院的为1.16（95%可信区间，0.4至3.34）。在84例未从出生医院出院回家的婴儿中，93%在12小时龄时出现症状，99%在18小时时出现症状。
大多数在新生儿期死亡的足月儿在出生后最初18小时内出现症状。我们未能证明出院回家后死亡的婴儿中早期出院与新生儿死亡率之间存在关联。
