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低出生體重早產兒出生後第一年內再入院研究

A Study of Readmission during the First Year of Life among Preterm Infants with Low Birth Weight

摘要


目標:本研究旨在探討低出生體重早產兒出生後一年內全病因及呼吸道感染再入院發生率及其預測因子。方法:本研究採回溯性世代研究設計,研究世代成員擷取自全民健康保險住院醫療清單明細檔(以下簡稱住院檔)中於2000~2002年間出生,且在此期間首次住院之出院診斷為ICD-9-CM:765共18,421名低出生體重早產兒;出生後第一年內除首次入院以外之再入院資料則是由2000-2003年之住院檔串聯個案加密之身份證字號獲得。結果:研究對象於出生後第一年內全病因及呼吸道感染再入院之累積發生率分別為37.2%與22.4%,發生密度則分別為167人次/100人年與139人次/100人年。多變量Cox迴歸模式分析結果顯示:男性、出生體重小於1,500公克、妊娠週數小於28週、具先天畸形、首次住院罹患慢性肺部疾病及父(或母)投保金額小於19,200元等因素均為發生再入院之顯著預測因子。結論:為降低低出生體重早產兒第一年之再入院率,應針對再入院高危險群加強實施周產期與新生兒照護分級制度,以提昇新生兒的健康狀態。此外,未來研究也應進一步評估針對早產兒肺部疾病所作照護措施(無法避免早期分娩的產婦於產前注射類固醇,以及產後給予可能發生呼吸窘迫症候群的早產兒肺表面活性物質)之成效,以期利用有效的臨床介入措施進一步降低早產兒之再入院率。

並列摘要


Objectives: The aims of this study were to estimate the incidences of readmission for all causes and for respiratory infection among preterm low-birth-weight infants during the first year of life and to explore significant predictors for readmission. Methods: For this retrospective cohort study, we enrolled 18,421 infants born and first hospitalized in 2000-2002 because of prematurity or low birth weight (International Classification of Diseases, Ninth Revision, Clinical Modification code 765) at discharge. The infants were identified from inpatient claims of our National Health Insurance. They were linked, by using scrambled personal identification numbers, to 2000-2003 inpatient claims data to identify all possible re-hospitalizations during infancy. Incidences of readmission, incidence density estimates, and predictors of readmission were analyzed. Results: Cumulative incidences of readmission for all causes and for respiratory infection were approximately 37.2% and 22.4%, respectively; respective incidence density estimates were 167 and 139 readmissions/100 person-years. Cox multivariate regression analysis indicated that male sex, birth weight < 1,500 g, gestational age < 28 weeks, congenital anomaly, chronic lung disease, and a parental insurance premium of < 19,200 NT dollars were significant predictors for readmission. Conclusions: To reduce readmission rates among preterm low-birth-weight infants, perinatal and newborn regionalization must be enforced to improve the health of those at increased risk for readmission. Future studies should be performed to assess the effectiveness of healthcare maneuvers, such as administering antenatal steroid therapy to those who will be born early and providing surfactant to premature babies who are vulnerable to respiratory distress syndrome. Effective maneuvers such as these may further reduce readmission rates among infant born preterm.

被引用紀錄


劉綉靖(2009)。早產兒出院ㄧ個月內主要照顧者的生活品質及相關因素探討〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2009.01379

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