Kahn D J, Richardson D K, Gray J E, Bednarek F, Rubin L P, Shah B, Frantz I D, Pursley D M
Joint Program in Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass 02215, USA.
Arch Pediatr Adolesc Med. 1998 Sep;152(9):844-51. doi: 10.1001/archpedi.152.9.844.
To compare rates of narcotic administration for medically treated neonates in different neonatal intensive care units (NICUs) and to compare treated and untreated neonates to assess whether narcotics provided advantages or disadvantages for short-term outcomes, such as cardiovascular stability (ie, blood pressure and heart rate), hyperbilirubinemia, duration of respiratory support, growth, and the incidence of intraventricular hemorrhage.
The medical charts of neonates weighing less than 1500 g, admitted to 6 NICUs (A-F), were abstracted. Neonates who had a chest tube or who had undergone surgery were excluded from the study, leaving the records of 1171 neonates. We modeled outcomes by linear or logistic regression, controlling for birth weight (<750, 750-999, and 1000-1499 g) and illness severity (low, 0-9; medium, 10-19; high, > or =20) using the Score for Neonatal Acute Physiology (SNAP), and adjusted for NICU.
Narcotic use varied by birth weight (<750 g, 21%; 750-999 g, 13%; and 1000-1499 g, 8%), illness severity (low, 9%; medium, 19%; and high, 37%), day (1, 11%; 3, 6%; and 14, 2%), and NICU. We restricted analyses to the 1018 neonates who received mechanical ventilation on day 1. Logistic regression, adjusting for birth weight and SNAP, confirmed a 28.6-fold variation in narcotic administration (odds ratios, 4.1-28.6 vs NICU A). Several short-term outcomes also were associated with narcotic use, including more than 33 g of fluid retention on day 3 and a higher direct bilirubin level (6.8 micromol/L higher [0.4 mg/dL higher], P = .03). There were no differences in weight gain at 14 and 28 days or mechanical ventilatory support on days 14 and 28. Narcotic use was not associated with differences in worst blood pressure or heart rate or with increased length of hospital stay.
Our study found a 28.6-fold variation among NICUs in narcotic administration in very low-birth-weight neonates. We were unable to detect any major advantages or disadvantages of narcotic use. We did not assess iatrogenic abstinence syndrome or long-term outcomes. These results indicate the need for randomized trials to rationalize these widely differing practices.
比较不同新生儿重症监护病房（NICU）中接受药物治疗的新生儿的麻醉药物使用比例，并比较接受治疗和未接受治疗的新生儿，以评估麻醉药物对短期预后（如心血管稳定性，即血压和心率、高胆红素血症、呼吸支持时间、生长情况及脑室内出血发生率）是产生了有利还是不利影响。
提取了入住6个NICU（A - F）的体重小于1500 g的新生儿的病历。将有胸管置入或接受过手术的新生儿排除在研究之外，最终留下1171名新生儿的记录。我们通过线性或逻辑回归对预后进行建模，使用新生儿急性生理学评分（SNAP）控制出生体重（<750 g、750 - 999 g和1000 - 1499 g）和疾病严重程度（低，0 - 9分；中，10 - 19分；高，≥20分），并对NICU进行了校正。
麻醉药物的使用因出生体重（<750 g为21%；750 - 999 g为13%；1000 - 1499 g为8%）、疾病严重程度（低为9%；中为19%；高为37%）、日龄（第1天为11%；第3天为6%；第14天为2%）以及NICU的不同而有所差异。我们将分析限制在第1天接受机械通气的1018名新生儿。在对出生体重和SNAP进行校正后，逻辑回归证实麻醉药物使用存在28.6倍的差异（比值比，与NICU A相比为4.1 - 28.6）。一些短期预后也与麻醉药物的使用有关，包括第3天液体潴留超过33 g以及直接胆红素水平更高（高6.8 μmol/L [高0.4 mg/dL]，P = 0.03）。在第14天和第28天的体重增加以及第14天和第28天的机械通气支持方面没有差异。麻醉药物的使用与最差血压或心率的差异以及住院时间延长无关。
我们的研究发现，极低出生体重新生儿的麻醉药物使用在各NICU之间存在28.6倍的差异。我们未能检测到麻醉药物使用的任何主要利弊。我们没有评估医源性戒断综合征或长期预后。这些结果表明需要进行随机试验，以使这些差异很大的做法合理化。
