Outcome and Cost of Intensive Care for Vert Low Birth Weight Infants

極低體重嬰兒住入加護病房後預後及醫療費用之評估

林瑛豐(Ying-Fong Lin) ； 林其和(Chyi-Her Lin) ； 林毓志(Yuh-Jyh Lin) ； 葉純甫(Tsu-Fuh Yeh)

《Acta Paediatrica Sinica》 36卷4期 (1995/08) Pp. 266-270

https://doi.org/10.7097/APS.199508.0266

摘要

極低體重嬰兒仍然為新生兒死亡及罹病的主要因素。新生兒加護病房的設立确定改善了這些嬰兒的預後。然而，院內出生與院外出生後再住入加護病房之嬰兒其預後可能不同。本研究的目的乃在比較此兩組嬰兒在新生兒加護病房照顧後，其死亡率、罹患并發症及醫療費用之差別。於1990年6月至1993年5月，三年期間總共有176位出生體重低於1500公克之嬰兒住入本院新生兒加護病房（院內：83位；院外生：93位）。其出生體重（1131±244公克與1133±255公克）、懷孕週數（29.0±4週與28.9±3.0週）及死亡率（32.9%與35.7%）并無差別。另外，腦室出血、呼吸窘迫症、敗血症、壞死性腸炎、視綱膜病變及聽力障礙等發生率亦然。但院外出生之極低出生體重嬰兒發生開放性動脈導管（47%與32%）及肺部慢性疾病（51%與29%）的機率較院內出生嬰兒高。其平均住院日數較長及醫療費用也較高。我們的結論為：院外出生再轉入新生兒加護病房之極低出生體重嬰兒其罹患并發症比率較高、住院日數較長、醫學中心應可減少醫療資源的消耗。

關鍵字

極低體重嬰兒 ； 預後 ； 醫療費用

並列摘要

Very low birth weights (VLBW) remain the major frictor contributing to neonatal mortality and morbidity. The development of Neonatal Intensive Care Units (NICU) has improved the outcome for the VLBW infants. However, outborn VLBW infants may have different outcomes, and different medical costs than those born intramurally. This study compared the mortality, morbidity and costs of inborn and outborn VLBW infants cared in the NJCU of a tertiary care center. A total of 176 VLBW infants (inborn 83, outborn 93) were examined over the three years period June 1990 to May 1993. The birth weights (1131±244 g vs 1133±255 g) and gestational ages (29.0±4.0 wk vs 28.9±3.0 wk) were not different between the two groups. However, the age of admission to our wards was significantly different between the inborn infants (5.0±3.2 hr.) and outborn infants (53.6±26.8 hr.). There was no difference in mortality rates between the outborn infants (35.7%) and the inborn infants (32.9%), nor in the incidence of intraventricular hemorrhage, respiratory distress syndrome, sepsis, necrotizing enterocolitis, retinopathy of prematurity or abnormal auditory brainstem response. However the incidence of patent ductus arteriosus and chronic lung disease of the outborn infants was higher than those of the inborn (47% vs 32%, 51% vs 29% respectively). The mean duration of hospitalization and cost seemed to be longer and higher in the outhorn VLBW infants. It was concluded that outborn VLBW infants have higher rates of morbidity, longer hospitalization and cost more than inborn infants. Therefore, the consumption of medical resources could be reduced through the intrauterine transport of the VLBW infants to the tertiary care center.

並列關鍵字

very low birth weight infants ； outcome ； medical cost