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Title Length of stay in neonatal intensive care unit in infants with bronchopulmonary dysplasia: a nation-wide cohort study
Author SAE YUN KIM, SO YOUNG KIM
작성자 김소영
Background Preterm birth rate is approximately 10% world-wide, and was 8.1% in South Korea in 2019 according to press release of Korea National Statistical Office. Among them, very preterm infants are at increased risk for bronchopulmonary dysplasia (BPD), which is one of most fatal respiratory morbidities in preterm infants, causing adverse respiratory and neurodevelopmental outcomes. In a recently published KNN (Korea Neonatal Network) study, 29.9% (1388/4662) of infants born between 23 and 31 weeks of gestation developed bronchopulmonary dysplasia1. Infants with BPD often spend in excess of four months in the neonatal intensive care unit (NICU) with some of the sickest patients spending over a year prior to discharge to home for the first time. Prolonged length of NICU stays positively correlate with increased exposure to infections, developmental delays as well as parent-infant relationships. Although, severity of BPD in preterm plays a role in length of stay in preterm infants, recognition of characteristics and factors associated with longer initial hospitalizations in the preterm infants with BPD is important step because individualized strategies to optimize the NICU experience for these critically ill patients, thus favoring long-term outcomes and to initiate attempts to reduce length of stay in these high-risk infants. However, to date, only one retrospective study from US2 covered this topic; lower birth weight and covered by public insurance had association with longer length of hospitalization. Clinical characteristics at discharge associated with longer initial hospitalizations included gastrostomy tube, mechanical ventilation, tracheostomy, pulmonary hypertension, and supplemental oxygen. In Korea, there was paucity of research analyzing data from this point of view.
Aim / Hypothesis To identify the characteristics associated with longer lengths of hospitalization in BPD patients
Inclusion Criteria 1) Date of Birth 2013.1.1-2020.12.31 2) VLBW infants registered in KNN registry 3) Infants who were diagnosed bronchopulmonary dysplasia 4) Gestational age : 24+0 ~ 32+6 weeks
Exclusion Criteria 1) Infants who were discharged to a non-neonatal facility (i.e. pediatric ward, PICU, rehabilitation or palliative care) before home 2) Infants who were stayed in neonatal units for longer than 12 months
Study Design Statistical methods [Study design] prospective cohort study [statistical method] 1) Basic demogrphic and clinical findings: descriptive statistics - chi-square test and Student’s t-test: comparing distributions of categorical variables and the continuous variables, respectively 2) univariate Cox regressions were used to identify potential confounders (demographic characteristics) associated with length of initial hospital stay. 3) univariate Cox regressions using clinical variables (independent variable) adjusted for demographic characteristics were used to identify specific clinical variables associated with age at initial discharge (independent variable). 4) significant clinical variables were used to build a multivariate Cox regression models to predict age at initial discharge (again adjusted for appropriate demographic characteristics) by backwards elimination of non-significant clinical variables. 5) p values < 0.05 were considered statistically significant.
Primary Outcomes Age at initial discharge by clinical/demographic characteristics for infants with BPD
Secondary Outcomes and Definitions Adjusted Cox hazzard ratio - Individual predictors of length of stay
Protocols As described above (method section)
Funding 해당사항 없음

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