目的 了解新生儿重症监护室（neonatal intensive care unit，NICU）患儿出院31 d内非计划再入院现状及其影响因素，为制定相关预防策略提供参考。 方法 回顾性收集1 561例NICU出院患儿临床资料，将31 d内发生再次入院的52例患儿作为病例组，采用1∶2病例对照研究的方法，选取同期住院后未发生再入院病例104例作为对照组，对两组患儿的临床资料行单因素分析和多因素logistic回归分析。 结果 1 561例患儿中，52例患儿共发生再入院63次，再入院率为3.33%。高胆红素血症和肺炎是再入院的主要原因，分别占29%（18/63）和24%（15/63）。多因素logistic回归分析结果显示，胎龄<28周、出生体重<1 500 g、多胎妊娠、机械通气、住院时间≤7 d是NICU出院患儿再入院的影响因素（分别OR值为5.645、5.750、3.044、3.331、1.718，P<0.05）。 结论 NICU出院患儿再入院风险较高，医护人员应关注其影响因素，制订针对性干预措施，减少再入院次数，提高医疗服务质量。
Abstract
Objective To investigate the current status of unplanned readmission of neonates within 31 days after discharge from the neonatal intensive care unit (NICU) and risk factors for readmission. Methods A retrospective analysis was performed on the medical data of 1 561 infants discharged from the NICU, among whom 52 infants who were readmitted within 31 days were enrolled as the case group, and 104 infants who were not readmitted after discharge during the same period of time were enrolled as the control group. Univariate analysis and multivariate logistic regression analysis were performed to identify the risk factors for readmission. Results Among the 1 561 infants, a total of 63 readmissions occurred in 52 infants, with a readmission rate of 3.33%. hyperbilirubinemia and pneumonia were the main causes for readmission, accounting for 29% (18/63) and 24% (15/63) respectively. The multivariate logistic regression analysis showed that that gestational age <28 weeks, birth weight <1 500 g, multiple pregnancy, mechanical ventilation, and length of hospital stay <7 days were risk factors for readmission (OR=5.645, 5.750, 3.044, 3.331, and 1.718 respectively, P<0.05). Conclusions Neonates have a relatively high risk of readmission after discharge from the NICU. The medical staff should pay attention to risk factors for readmission and formulate targeted intervention measures, so as to reduce readmission and improve the quality of medical service.
关键词
新生儿重症监护 /
非计划再入院 /
影响因素 /
新生儿
Key words
Neonatal intensive care unit /
Unplanned readmission /
Risk factor /
Neonate
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 徐雅君, 谢袁丽. 新生儿重症监护室患儿父母出院准备需求的质性研究[J]. 中华现代护理杂志, 2021, 27(28): 3877-3880. DOI: 10.3760/cma.j.cn115682-20201203-06505.
2 Rose C, Ramsay L, Leaf A. Strategies for getting preterm infants home earlier[J]. Arch Dis Child, 2008, 93(4): 271-273. PMID: 17942584. DOI: 10.1136/adc.2005.093039.
3 Swain MJ, Kharrazi H. Feasibility of 30-day hospital readmission prediction modeling based on health information exchange data[J]. Int J Med Inform, 2015, 84(12): 1048-1056. PMID: 26412010. DOI: 10.1016/j.ijmedinf.2015.09.003.
4 Bapat R, McClead R, Shepherd E, et al. Challenges, successes and opportunities for reducing readmissions in a referral-based children's hospital NICU[J]. J Neonatal Perinatal Med, 2016, 9(4): 433-440. PMID: 28009334. DOI: 10.3233/NPM-161624.
5 陈涛蓉, 胡艳玲, 万兴丽. 三级甲等医院新生儿科高危新生儿再入院原因分析及对策[J]. 中国实用护理杂志, 2017, 33(z1): 6-9. DOI: 10.3760/cma.j.issn.1672-7088.2017.z1.002.
6 申悦. 新生儿再入院临床分析[D]. 重庆: 重庆医科大学, 2018.
7 朱蓓, 许昌, 吴瑞芳, 等. 公立医院产科31天非计划再入院影响因素分析[J]. 中华医院管理杂志, 2020, 36(2): 122-126. DOI: 10.3760/cma.j.issn.1000-6672.2020.02.008.
8 Markham JL, Hall M, Gay JC, et al. Length of stay and cost of pediatric readmissions[J]. Pediatrics, 2018, 141(4): e20172934. PMID: 29523706. DOI: 10.1542/peds.2017-2934.
9 Aykanat Girgin B, Cimete G. Rehospitalization of preterm infants according to the discharge risk level[J]. J Spec Pediatr Nurs, 2017, 22(1): 12165. PMID: 27925447. DOI: 10.1111/jspn.12165.
10 Escobar GJ, Greene JD, Hulac P, et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gestations[J]. Arch Dis Child, 2005, 90(2): 125-131. PMID: 15665162. PMCID: PMC1720242. DOI: 10.1136/adc.2003.039974.
11 肖万祥, 杨婷, 张炼. 新生儿高胆红素血症再入院的现状和危险因素分析[J]. 中国当代儿科杂志, 2020, 22(9): 948-952. PMID: 32933624. PMCID: PMC7499455. DOI: 10.7499/j.issn.1008-8830.2005003.
12 Ray KN, Lorch SA. Hospitalization of early preterm, late preterm, and term infants during the first year of life by gestational age[J]. Hosp Pediatr, 2013, 3(3): 194-203. PMID: 24313087. DOI: 10.1542/hpeds.2012-0063.
13 Ambalavanan N, Carlo WA, McDonald SA, et al. Identification of extremely premature infants at high risk of rehospitalization[J]. Pediatrics, 2011, 128(5): e1216-e1225. PMID: 22007016. PMCID: PMC3208965. DOI: 10.1542/peds.2011-1142.
14 Lamarche-Vadel A, Blondel B, Truffer P, et al. Re-hospitalization in infants younger than 29 weeks' gestation in the EPIPAGE cohort[J]. Acta Paediatr, 2004, 93(10): 1340-1345. PMID: 15499955. DOI: 10.1080/08035250410032926.
15 Stephens AS, Lain SJ, Roberts CL, et al. Survival, hospitalization, and acute-care costs of very and moderate preterm infants in the first 6 years of life: a population-based study[J]. J Pediatr, 2016, 169: 61-68.e3. PMID: 26561378. DOI: 10.1016/j.jpeds.2015.10.028.
16 Harron K, Gilbert R, Cromwell D, et al. Newborn length of stay and risk of readmission[J]. Paediatr Perinat Epidemiol, 2017, 31(3): 221-232. PMID: 28418622. PMCID: PMC5518288. DOI: 10.1111/ppe.12359.
17 Feng BB, Zhai JJ, Cai Y. Effect of twin pregnancy chorionic properties on maternal and fetal outcomes[J]. Taiwan J Obstet Gynecol, 2018, 57(3): 351-354. PMID: 29880163. DOI: 10.1016/j.tjog.2018.03.002.
18 刘丽丽. 早产危险因素的Meta分析[D]. 乌鲁木齐: 新疆医科大学, 2016.
19 Boykova M, Kenner C. Transition from hospital to home for parents of preterm infants[J]. J Perinat Neonatal Nurs, 2012, 26(1): 81-87; quiz 88-89. PMID: 22293645. DOI: 10.1097/JPN.0b013e318243e948.
20 Do CHT, B?rresen ML, Pedersen FK, et al. Rates of rehospitalisation in the first 2 years among preterm infants discharged from the NICU of a tertiary children hospital in Vietnam: a follow-up study[J]. BMJ Open, 2020, 10(10): e036484. PMID: 33020086. PMCID: PMC7537446. DOI: 10.1136/bmjopen-2019-036484.
21 Kuint J, Lerner-Geva L, Chodick G, et al. Rehospitalization through childhood and adolescence: association with neonatal morbidities in infants of very low birth weight[J]. J Pediatr, 2017, 188: 135-141.e2. PMID: 28662947. DOI: 10.1016/j.jpeds.2017.05.078.
22 Hannan KE, Hwang SS, Bourque SL. Readmissions among NICU graduates: who, when and why?[J]. Semin Perinatol, 2020, 44(4): 151245. PMID: 32253024. DOI: 10.1016/j.semperi.2020.151245.
23 Danielsen B, Castles AG, Damberg CL, et al. Newborn discharge timing and readmissions: California, 1992-1995[J]. Pediatrics, 2000, 106(1 Pt 1): 31-39. PMID: 10878146. DOI: 10.1542/peds.106.1.31.
24 Patel N, Ballantyne A, Bowker G, et al. Family integrated care: changing the culture in the neonatal unit[J]. Arch Dis Child, 2018, 103(5): 415-419. PMID: 29122741. DOI: 10.1136/archdischild-2017-313282.
PDF(514 KB)
