新生儿重症监护室低血糖新生儿住院期间医疗费用的影响因素分析

Influencing factors of economic burden during hospitalization of neonates with hypoglycemia in NICU

背景新生儿严重持续的低血糖会导致不可逆的神经系统损伤,给家庭和社会造成极大负担。目的探讨NICU低血糖新生儿住院期间医疗费用的影响因素。设计横断面研究。方法回顾性纳入2014年1月1日至2022年12月31日郑州大学附属儿童医院NICU收住的低血糖新生儿。新生儿低血糖诊断金标准:全血血糖<2.2 mmol·L~(-1)或血浆糖<2.5 mmol·L~(-1),全血血糖<2.6 mmol·L~(-1)为临床需要处理的界值~([8]),新生儿低血糖分类参照《新生儿低血糖临床规范管理专家共识(2021)》。采集新生儿的一般情况、围生期情况、实验室和辅助检查、治疗结局和住院期间的医疗费用。采用广义线性回归探讨影响住院期间医疗费用的因素。主要结局指标NICU低血糖新生儿住院总费用。结果176例低血糖新生儿纳入本文分析,男104例(59.1%),女72例。中位日龄4(2,9)d。住院期间总费用(人民币)中位数为15438(10670,23490)元,中位住院天数11.0(8.0,16.8)d。单因素秩和检验结果显示,有感染症状、围生期脑损伤、母亲分娩次数>1次、围生期不良因素>4个和治疗结局好转均增加住院总费用,差异均有统计学意义。新生儿血钾、头颅MR异常和有低血糖脑损伤增加住院总费用,差异均有统计学意义。多元广义回归结果显示,有感染症状、代谢性疾病、母亲分娩次数>1次、围生期不良因素>4个和低血糖脑损伤是住院总费用的危险因素。结论有感染症状、代谢性疾病、母亲分娩次数>1次、围生期不良因素>4个和低血糖脑损伤新生儿住院期间的经济负担较重。

Background There are many factors affecting neonatal hypoglycemia,and severe and persistent hypoglycemia can lead to irreversible neurological damage,posing a great burden to families and society.Objective To explore the influencing factors of economic burden during hospitalization for NICU neonates with hypoglycemia.Design Cross-sectional study.Methods Hypoglycemic neonates admitted to the NICU of Children's Hospital of Zhengzhou University from January 1,2014 to December 31,2022 were retrospectively included.The gold standard for neonatal hypoglycemia diagnosis is whole blood glucose<2.2 mmol·L-1 or plasma glucose<2.5 mmol·L-1,and whole blood glucose<2.6 mmol·L-1 was the cut-off value for clinical management.The classification of neonatal hypoglycemia was based on the Expert Consensus on the Clinical Standardized Management of Neonatal Hypoglycemia(2021).The general condition,perinatal condition,clinical examination index,prognosis and hospitalization expenses of the children were collected.Generalized linear regression was used to investigate the factors affecting medical expenses during hospitalization.Main outcome measures The total hospitalization expenses of neonates with hypoglycemia in NICU.Results A total of 176 newborns with hypoglycemia were included in this analysis,of which 104(59.1%)were male and 72 were female.The median age was 4(2,9)days.The median total hospitalization cost in RMB was 15,438(10,670,23,490)yuan,and the median length of hospital stay was 11.0(8.0,16.8)days.Univariate rank-sum test results indicated that symptoms of infection,perinatal brain injury,multiple maternal delivery times,more than four adverse perinatal factors,and improved treatment outcomes all increased the total hospitalization cost,with statistically significant differences.Neonatal blood potassium,C-peptide,abnormal cranial MRI,and hypoglycemic brain injury also increased the total hospitalization cost,with statistically significant differences.Multivariate generalized regression results showed that symptoms of infection,metabolic diseases,multiple maternal delivery times,more than four adverse perinatal factors,and hypoglycemic brain injury were risk factors for the total hospitalization cost.Conclusion Newborns with symptoms of infection,metabolic diseases,multiple maternal delivery times,more than four adverse perinatal factors,and hypoglycemic brain injury bear a heavier economic burden during hospitalization.