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

A retrospective analysis of unplanned hospital readmissions of high-risk neonates in a tertiary hospital

目的 探讨高危新生儿二次入院的原因与对策.方法 在查阅文献的基础上,并经科室护理质量管理小组反复讨论,自行设计《高危新生儿再入院原因分析的资料收集表》,回顾性分析我科2015年1-10月再入院患儿的病例资料.结果 我科2015年1-10月出院患者3012例,再入院106例,再入院率为3.52%.再入院的平均间隔时间为(4.92±4.0)d,再入院间隔时间以7 d内为主占83.95%,其中≤3 d41例占38.68%、4~7 d48例占45.28%、>7 d17例占16.03%;早产儿组与足月儿组相比较,早产儿在3 d内的再入院率为21.69%(23/106),高于足月儿在3 d之内的再入院率16.98%(18/106),差异无统计学意义(χ2=1.45,P>0.05);早产儿在7 d之内的再入院率为49.06%(52/106),高于足月儿在7 d内的再入院率34.91%(37/106),差异有统计学意义(χ2=5.45,P<0.05);再入院原因主要以黄疸(构成比为50.94%)为主、其次为感染(构成比为30.19%);再次住院时,诊断与首次相同或相关疾病入院者占53.77%(其中以高胆红素血症与肺炎为主);低出生体质量儿与正常出生体质量儿(体质量≥2500g)相比,喂养不当造成再次入院的差异无统计学意义(χ2=3.58,P>0.05);早产儿与足月儿(胎龄≥37周)相比,喂养不当造成再次入院的差异有统计学意义(χ2=5.83,P<0.05).结论 出院后1周是发生再入院的高峰时间.早产儿是发生再入院的主要人群,黄疸是导致再入院的主要因素.早产儿比足月儿更容易因喂养不当而导致再入院.

Objective To explore the causes and solutions of rehospitalization of the high-risk neonates. Methods The data collection form was designed based on the literature reviewing and the discussion of the nursing quality management team. Results The samples were retrospectively collected from January 2015 to October 2015. There were 106 cases readmitted among the 3012 discharged cases with the ratio of 3.52%. The average interval of readmission were (4.92±4.0) days, most of the cases were readmitted in 7 days after the first discharge with a ratio of 83.95%, the ratio of readmission within 3 days was 38.68%and that was 45.28%for the readmission within 4~7days. For the Preterm infants, the ratio of readmission within 3 days was 21.69%which was higher than that of the full term (16.98%), there was no statistically significant difference between the two groups(chi-square= 1.45, P>1.45). While the ratio of readmission within 7 days for premature infants was 49.06%(52/106), which was higher than that of full term infants [34.91%(37/106)], and there was statistically significant difference between the two groups(chi-square = 5.45, P<0.05). Jaundice was found to be the major reason for unplanned rehospitalization with the ratio of 50.94%. When compared the incidence of readmission contributed by improper feeding between the low birth weigh and normal birth weight infants, there was nostatistical significance (chi-square = 3.58, P>3.58). But when compared between preterm infants and full term, a higher ratio was found in preterm infants (16.04%), and there was statistically significant difference (chi-square = 5.83, P< 0.05). Conclusion One week after discharge was the peak time of readmission.Jaundice was the main factor of readmission. Premature babies were more likely to have readmission due to feeding problems.