Background:Newborns of 30-34 weeks gestation comprise 3.9%of all live births in the United States and 32%of all premature infants. They have been studied much less than very low birthweight infants. Objective:To measu...Background:Newborns of 30-34 weeks gestation comprise 3.9%of all live births in the United States and 32%of all premature infants. They have been studied much less than very low birthweight infants. Objective:To measure in-hospital outcomes and readmission within three months of discharge of moderately premature infants. Design:Prospective cohort study including retrospective chart review and telephone interviews after discharge. Setting:Ten birth hospitals in California and Massachusetts. Patients:Surviving moderately premature infants born between October 2001 and February 2003.Main outcome measures:(a) Occurrence of assisted ventilation during the hospital stay after birth; (b) adverse in-hospital outcomes-for example,necrotising enterocolitis; (c) readmission within three months of discharge. Results:With the use of prospective cluster sampling,850 eligible infants and their families were identified,randomly selected,and enrolled. A total of 677 families completed a telephone interview three months after hospital discharge. During the birth stay,these babies experienced substantial morbidity:45.7%experienced assisted ventilation,and 3.2%still required supplemental oxygen at 36 weeks. Readmission within three months occurred in 11.2%of the cohort and was higher among male infants and those with chronic lung disease. Conclusions:Moderately premature infants experience significant morbidity,as evidenced by high rates of assisted ventilation,use of oxygen at 36 weeks,and readmission. Such morbidity deserves more research.展开更多
Objective: To examine temporal trends in the rates of severe bronchopulmonary dysplasia (BPD) between 1994 and 2002. Study design: In a retrospective cohort study, all infants with a gestational age (GA) < 33 weeks...Objective: To examine temporal trends in the rates of severe bronchopulmonary dysplasia (BPD) between 1994 and 2002. Study design: In a retrospective cohort study, all infants with a gestational age (GA) < 33 weeks in a large managed car e organization were identified. Annual rates of BPD (defined as an oxygen requir ement at 36 weeks corrected GA), severe BPD (defined as respiratory support at 3 6 weeks corrected GA), and death before 36 weeks corrected GA were examined. Res ults: Of the 5115 infants in the study cohort, 603 (12% ) had BPD, including 24 6 (4.9% ) who had severe BPD. There were 481 (9.5% ) deaths before 36 weeks co rrected GA. Although the decline in BPD in this period was not significant, the rates of severe BPD declined from 9.7% in 1994 to 3.7% in 2002. Controlling for gestational age, the odds ratio (95% CI) for annual rate of decline in severe BPD was 0.890 (0.841- 0.941). Controlling for gestational ag e, deaths before 36 weeks corrected GA also declined, with the odds ratio (CI) f or the annual decline being 0.944 (0.896- 0.996). Conclusions: In this study po pulation, the odds of having of BPD remained constant after controlling for GA. However, the odds of having severe BPD declined on average 11% per year betwee n 1994 and 2002.展开更多
Objective:To compare gestational age at discharge between infants born at 30-34+6 weeks gestational age who were admitted to neonatal intensive care units (NICUs) in California,Massachusetts,and the United Kingdom. De...Objective:To compare gestational age at discharge between infants born at 30-34+6 weeks gestational age who were admitted to neonatal intensive care units (NICUs) in California,Massachusetts,and the United Kingdom. Design:Prospective observational cohort study. Setting:Fifty four United Kingdom,five California,and five Massachusetts NICUs. Subjects:A total of 4359 infants who survived to discharge home after admission to an NICU. Main outcome measures:Gestational age at discharge home. Results:The mean (SD) postmenstrual age at discharge of the infants in California,Massachusetts,and the United Kingdom were 35.9 (1.3),36.3 (1.3),and 36.3(1.9)weeks respectively (p = 0.001). Compared with the United Kingdom,adjusted discharge of infants occurred 3.9 (95%confidence interval (CI) 1.4 to 6.5) days earlier in California,and 0.9 (95%CI -1.2 to 3.0) days earlier in Massachusetts. Conclusions:Infants of 30-34+6 weeks gestation at birth admitted and cared for in hospitals in California have a shorter length of stay than those in the United Kingdom. Certain characteristics of the integrated healthcare approach pursued by the health maintenance organisation of the NICUs in California may foster earlier discharge. The California system may provide opportunities for identifying practices for reducing the length of stay of moderately premature infants.展开更多
文摘Background:Newborns of 30-34 weeks gestation comprise 3.9%of all live births in the United States and 32%of all premature infants. They have been studied much less than very low birthweight infants. Objective:To measure in-hospital outcomes and readmission within three months of discharge of moderately premature infants. Design:Prospective cohort study including retrospective chart review and telephone interviews after discharge. Setting:Ten birth hospitals in California and Massachusetts. Patients:Surviving moderately premature infants born between October 2001 and February 2003.Main outcome measures:(a) Occurrence of assisted ventilation during the hospital stay after birth; (b) adverse in-hospital outcomes-for example,necrotising enterocolitis; (c) readmission within three months of discharge. Results:With the use of prospective cluster sampling,850 eligible infants and their families were identified,randomly selected,and enrolled. A total of 677 families completed a telephone interview three months after hospital discharge. During the birth stay,these babies experienced substantial morbidity:45.7%experienced assisted ventilation,and 3.2%still required supplemental oxygen at 36 weeks. Readmission within three months occurred in 11.2%of the cohort and was higher among male infants and those with chronic lung disease. Conclusions:Moderately premature infants experience significant morbidity,as evidenced by high rates of assisted ventilation,use of oxygen at 36 weeks,and readmission. Such morbidity deserves more research.
文摘Objective: To examine temporal trends in the rates of severe bronchopulmonary dysplasia (BPD) between 1994 and 2002. Study design: In a retrospective cohort study, all infants with a gestational age (GA) < 33 weeks in a large managed car e organization were identified. Annual rates of BPD (defined as an oxygen requir ement at 36 weeks corrected GA), severe BPD (defined as respiratory support at 3 6 weeks corrected GA), and death before 36 weeks corrected GA were examined. Res ults: Of the 5115 infants in the study cohort, 603 (12% ) had BPD, including 24 6 (4.9% ) who had severe BPD. There were 481 (9.5% ) deaths before 36 weeks co rrected GA. Although the decline in BPD in this period was not significant, the rates of severe BPD declined from 9.7% in 1994 to 3.7% in 2002. Controlling for gestational age, the odds ratio (95% CI) for annual rate of decline in severe BPD was 0.890 (0.841- 0.941). Controlling for gestational ag e, deaths before 36 weeks corrected GA also declined, with the odds ratio (CI) f or the annual decline being 0.944 (0.896- 0.996). Conclusions: In this study po pulation, the odds of having of BPD remained constant after controlling for GA. However, the odds of having severe BPD declined on average 11% per year betwee n 1994 and 2002.
文摘Objective:To compare gestational age at discharge between infants born at 30-34+6 weeks gestational age who were admitted to neonatal intensive care units (NICUs) in California,Massachusetts,and the United Kingdom. Design:Prospective observational cohort study. Setting:Fifty four United Kingdom,five California,and five Massachusetts NICUs. Subjects:A total of 4359 infants who survived to discharge home after admission to an NICU. Main outcome measures:Gestational age at discharge home. Results:The mean (SD) postmenstrual age at discharge of the infants in California,Massachusetts,and the United Kingdom were 35.9 (1.3),36.3 (1.3),and 36.3(1.9)weeks respectively (p = 0.001). Compared with the United Kingdom,adjusted discharge of infants occurred 3.9 (95%confidence interval (CI) 1.4 to 6.5) days earlier in California,and 0.9 (95%CI -1.2 to 3.0) days earlier in Massachusetts. Conclusions:Infants of 30-34+6 weeks gestation at birth admitted and cared for in hospitals in California have a shorter length of stay than those in the United Kingdom. Certain characteristics of the integrated healthcare approach pursued by the health maintenance organisation of the NICUs in California may foster earlier discharge. The California system may provide opportunities for identifying practices for reducing the length of stay of moderately premature infants.
