Intensive Care Unit Readmission during Childhood after Preterm Birth with Respiratory Failure

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• 作者：Peter M. Mourani ; MD¹ ; ^{peter.mourani@childrenscolorado.org" class="auth_mail} ; John P. Kinsella ; MD¹ ; Gilles Clermont ; MD ; MSc² ; Lan Kong ; PhD² ; ³ ; Amy M. Perkins ; MS² ; ³ ; Lisa Weissfeld ; PhD² ; ³ ; Gary Cutter ; PhD⁴ ; Walter T. Linde-Zwirble⁵ ; Steven H. Abman ; MD¹ ; Derek C. Angus ; MD ; MPH² ; R. Scott Watson ; MD ; MPH² ; on behalf of the Prolonged Outcomes after Nitric Oxide (PrONOx) Investigators &lowast
• 关键词：CLD ; Chronic lung disease ; ICH ; Intracranial hemorrhage ; ICU ; Intensive care unit ; iNO ; Inhaled nitric oxide ; LOS ; Length of stay ; NDI ; Neurodevelopmental impairment ; NICU ; Neonatal intensive care unit
• 刊名：The Journal of Pediatrics
• 出版年：April, 2014
• 年：2014
• 卷：164
• 期：4
• 页码：749-755.e3
• 全文大小：299 K

文摘

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Objective

To determine the incidence and risk factors for readmission to the intensive care unit (ICU) among preterm infants who required mechanical ventilation at birth.

Study design

We studied preterm newborns (birth weight 500-1250 g) who required mechanical ventilation at birth and were enrolled in a multicenter trial of inhaled nitric oxide therapy. Patients were assessed up to 4.5 years of age via annual in-person evaluations and structured telephone interviews. Univariate and multivariable analyses of baseline and birth hospitalization predictors of ICU readmission were performed.

Results

Of 512 subjects providing follow-up data, 58% were readmitted to the hospital (51% of these had multiple readmissions, averaging 3.9 readmissions per subject), 19% were readmitted to an ICU, and 12% required additional mechanical ventilation support. In univariate analyses, ICU readmission was more common among male subjects (OR 2.01; 95% CI 1.27-3.18), infants with grade 3-4 intracranial hemorrhage (OR 2.13; 95% CI 1.23-3.69), increasing duration of birth hospitalization (OR 1.01 per day; 95% CI 1.00-1.02), and prolonged oxygen therapy (OR 1.01 per day; 95% CI 1.00-1.01). In the first year after birth hospitalization, children readmitted to an ICU incurred greater health care costs (median $69鈥?00 vs $30鈥?00 for subjects admitted to the ward and $9600 for subjects never admitted).

Conclusions

Small preterm infants who were mechanically ventilated at birth have substantial risk for readmission to an ICU and late mechanical ventilation, require extensive health care resources, and incur high treatment costs.