按新生儿重症监护室工作量和地区组别划分的极低出生体重儿死亡率。

IF 3.2 Q1 PEDIATRICS
Clinical and Experimental Pediatrics Pub Date : 2024-11-01 Epub Date: 2024-09-12 DOI:10.3345/cep.2023.01613
Sung-Hoon Chung, Chae Young Kim, Yong-Sung Choi, Myung Hee Lee, Jae Woo Lim, Byong Sop Lee, Ki-Soo Kim
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引用次数: 0

摘要

背景:受新生儿重症监护室(NICU)护理质量的影响,极低出生体重儿(VLBWI)仍然面临着很高的死亡率风险。目的:本研究旨在评估新生儿重症监护室的结构和人员属性如何影响极低出生体重儿的死亡率,强调医务人员的可用性和护理设施的区域分布的重要性:对韩国新生儿网络在 2015 年 1 月至 2016 年 12 月间收集的 69 所韩国新生儿重症监护室的数据进行了回顾性分析。新生儿重症监护室按各种参数分类:容量(小、中、大)、护士与床位比(1-4)和区域位置(A、B、C)。此外,还对儿科医生的配备情况进行了分析,并将新生儿重症监护室按儿科医生人均床位数分为低(≤10)、中(11-15)和高(≥16)。新生儿重症监护室按死亡率分为高绩效(第一和第二四分位数)和低绩效(第三和第四四分位数)。采用多变量逻辑回归分析了人口统计学、围产期和新生儿结局,以探讨新生儿重症监护室特征与死亡率之间的关系:这项研究共纳入了 4,745 例超低体重儿(平均胎龄 28.4 周;平均出生体重 1,088 克;55.4% 为男性),发现各新生儿重症监护室的存活率存在显著差异,这与绩效和人员配置水平有关。绩效高的新生儿重症监护室通常床位与工作人员的比例较低,护理水平较高,存活率也较高。值得注意的是,有两名而非一名新生儿科医生的新生儿重症监护室死亡率较低。研究还强调了地区差异,某些地区的新生儿重症监护室存活率较低:结论:充足的新生儿重症监护室人员配备和适当的设施位置是降低低体重儿死亡人数的关键。加强人员配备和地区医疗保健的公平性对于提高这一人群的存活率至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mortality of very low birth weight infants by neonatal intensive care unit workload and regional group status.

Background: Very low birth weight infants (VLBWIs) continue to face high mortality risk influenced by the care quality of neonatal intensive care units (NICUs). Under-standing the impact of workload and regional differences on these rates is crucial for improving outcomes.

Purpose: This study aimed to assess how the structural and staffing attributes of NICUs influence the mortality rates of VLBWIs, emphasizing the significance of the availability of medical personnel and the regional distribution of care facilities.

Methods: Data from 69 Korean NICUs collected by the Korean Neonatal Network between January 2015 and December 2016 were retrospectively analyzed. The NICUs were classified by various parameters: capacity (small, medium, large), nurse-to-bed ratio (1-4), and regional location (A, B, C). Pediatrician staffing was also analyzed and NICUs categorized by beds per pediatrician into low (≤10), medium (11-15), and high (≥16). The NICUs were classified by mortality rates into high-performance (1st and 2nd quartiles) and low-performance (3rd and 4th quartiles). Demographic, perinatal, and neonatal outcomes were analyzed using multivariate logistic regression to explore the association between NICU characteristics and mortality rates.

Results: This study included 4,745 VLBWIs (mean gestational age, 28.4 weeks; mean birth weight, 1,088 g; 55.4% male) and found significant variations in survival rates across NICUs linked to performance and staffing levels. High-performing NICUs, often with lower bed-to-staff ratios and advanced care levels, had higher survival rates. Notably, NICUs with 2 rather than 1 neonatologist were associated with reduced mortality rates. The study also underscored regional disparities, with NICUs in certain areas showing less favorable survival rates.

Conclusion: Adequate NICU staffing and proper facility location are key to lowering the number of VLBWI deaths. Enhancing staffing and regional healthcare equity is crucial for improving the survival of this population.

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CiteScore
8.00
自引率
2.40%
发文量
88
审稿时长
60 weeks
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