極低出生體重早產兒出院後醫療資源利用與預後—一與未加入早產兒追蹤小組之比較

研究目的極低出生體重（very low birth weight,VLBW ）早產兒，其首次住院醫療資源耗用情形，已有研究。然而，這些早產兒出院後二年期間，醫療資源耗用情形卻鮮有報告。本研究目的旨在分析極低出生體重早產兒出生後的醫療資源耗用狀況。並探討影響醫療資源耗用的相關因素。研究方法採回溯性研究方式，研究對象為89年度雲嘉南地區出生之一般足月新生兒、極低出生體重早產兒（N=156）兩個族群。將極低出生體重早產兒分為加入早產兒追蹤小組（N=120）與未加入組（N=36）。研究變項包含：出生胎數、妊娠週數、出生體重、合併症、存活狀況以及住院天數、住院總費用、門診次數、門診費用等。資料分析以Excel軟體做篩選，採用SPSS統計軟體進行描述性及推論性統計。研究結果 1. 極低出生體重早產兒門診費用高於一般足月新生兒門診費用（30：1）。 2. 追蹤之極低出生體重早產兒醫療資源耗用情形高於未追蹤早產兒（3：1）。 3. 追蹤小組與未追蹤小組之早產兒，在出院二年後二組費用差距顯著拉近。 4. 加入追蹤小組之極低出生體重早產兒的存活率與預後優於追蹤外之早產兒。討論與建議極低出生體重早產兒的照護，耗用相當可觀的醫療資源，如何降低極低出生體重早產兒的發生率，以及如何將已出生的極低出生體重早產兒，以個案疾病管理的模式作有計劃的門診追蹤外，應該有更積極且完整性的居家照護規劃，才能提昇早產兒的照護品質。

關鍵字

個案疾病管理；醫療資源利用；早產兒追蹤小組；極低出生體重早產兒

並列摘要

The Healthcare Resource Utilization and Outcome of Very Low Birth Weight Infants in the First 2 Years after Initial Neonatal Hospitalization —A Comparison with Non-Followup Group Objective : This study was undertaken to evaluate the difference of cost and outcome between VLBW-follow up and VLBW-non follow up infants during the first two years after NICU-discharge. Study design: This was a retrospective review of prospectively collected data on neurodevelopmental outcome and medical cost in the first two years after initial neonatal hospitalization for all infants born in 2000 with birth weight < 1500g in the area of Tainan-Chiayi-Yuling ( N=156). A comparison VLBW-infants and full term newborn, and comparison of two groups of VLBW infants divided into follow-up (N=120) and non follow-up infants (N=36). Standard statistical methods for continuous and non-continuous data and regression procedures were performed. Results : 1. The medical care cost of VLBW infants in the first two years after neonatal initial hospitalization was higher than full term newborn (30：1) 2. The medical care cost of VLBM-follow up infants was higher than non-follow up group (3:1) 3. The medical care cost between follow-up and non-follow up of VLBW infants become no difference after 2 years. 4. The outcome and mortality of follow-up group was much better compared with the non follow-up infants. Conclusion : Neonatal intensive care and its sequelae are certainly very expensive, especially the very-low-birth-weight infants. How to avoid premature labor and prematurity is essential. Early educational intervention relying on a intensive schedule of home-visiting and center-based approaches resulted in substantial gains in cognitive and behavioral development even among those very-low-birth-weight infants.