Nachman S A, Navaie-Waliser M, Qureshi M Z
Department of Pediatrics, School of Medicine, State University of New York at Stony Brook, Stony Brook, New York 11794-8111, USA.
Pediatrics. 1997 Dec;100(6):E8. doi: 10.1542/peds.100.6.e8.
This study sought to determine 1) the incidence of rehospitalization with respiratory syncytial virus (RSV) infection within a 3-year follow-up among infants discharged from the neonatal intensive care unit (NICU), and 2) to examine associations between age at readmission and medical and sociodemographic characteristics among infants rehospitalized with RSV.
A 3-year retrospective review of NICU discharges at a tertiary care center identified 2506 infants. Using medical record numbers linked with International Classification of Diseases, 9th ed, diagnostic codes for RSV infection, bronchiolitis, or respiratory distress, 67 NICU graduates were identified as having been readmitted from November to April (RSV season). Bivariate analyses and logistic regression modeling were applied to determine the association between a series of predictor variables and age at readmission with RSV by 90 days, 125 days, and 180 days after discharge from the NICU.
The 3-year incidence of readmission with RSV infection after NICU discharge was 2.7%. During the 3-year follow-up, 6.4% of very low birth weight infants, 2.8% of low birth weight infants, and 1.7% of normal weight infants were readmitted with RSV. Crude results revealed that the presence of bacteremia, intraventricular hemorrhage, and necrotizing enterocolitis, as well as ventilation use, were associated with younger age at readmission with RSV. Simultaneous consideration of the effects of all of these medical predictors and birth weight on age at readmission revealed that normal birth weight was the only significant factor associated with younger age at readmission with RSV.
This study found significantly lower rates of RSV readmission among NICU graduates than those reported previously in the literature. Based on these data, prophylactic treatment of all preterm infants may not be warranted.
本研究旨在确定1）新生儿重症监护病房（NICU）出院婴儿在3年随访期间因呼吸道合胞病毒（RSV）感染再次住院的发生率，以及2）研究再次住院的婴儿再次入院时的年龄与医学和社会人口学特征之间的关联。
对一家三级医疗中心的NICU出院病例进行了为期3年的回顾性研究，共识别出2506名婴儿。通过与国际疾病分类第9版相关的病历号，查找RSV感染、细支气管炎或呼吸窘迫的诊断代码，确定67名NICU毕业生在11月至4月（RSV季节）再次入院。采用双变量分析和逻辑回归模型，确定一系列预测变量与NICU出院后90天、125天和180天因RSV再次入院年龄之间的关联。
NICU出院后因RSV感染再次住院的3年发生率为2.7%。在3年随访期间，6.4%的极低出生体重婴儿、2.8%的低出生体重婴儿和1.7%的正常体重婴儿因RSV再次入院。粗略结果显示，菌血症、脑室内出血、坏死性小肠结肠炎的存在以及通气的使用与因RSV再次入院时的年龄较小有关。同时考虑所有这些医学预测因素和出生体重对再次入院年龄的影响后发现，正常出生体重是与因RSV再次入院时年龄较小相关的唯一显著因素。
本研究发现，NICU毕业生中RSV再次入院率明显低于先前文献报道的水平。基于这些数据，可能无需对所有早产儿进行预防性治疗。
