NICU Admissions for Meconium Aspiration Syndrome before and after a National Resuscitation Program Suctioning Guideline Change
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection
2.2. Data Analysis
3. Results
3.1. All Infants
3.2. Infants with 1-Minute Apgar Scores ≤3
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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2013 to 2015 N = 222,438 | 2017 N = 78,712 | |
---|---|---|
Maternal Characteristics | ||
Race, % | ||
White non-Hispanic | 58.7 | 56.3 |
African American | 17.3 | 18.3 |
Hispanic | 15.5 | 16.1 |
Other | 8.5 | 9.3 |
Hypertension, % | 17.8 | 20.6 |
Chorioamnionitis, % | 11.8 | 11.1 |
Infant Characteristics | ||
Gestational age, weeks, median (q1, q3) | 38 (36, 39) | 38 (36, 39) |
Birth weight, grams, median (q1, q3) | 3120 (2635, 3580) | 3118 (2635, 3570) |
Male, % | 56.5 | 56.6 |
Small for gestation, % | 18.8 | 19.0 |
1 min Apgar score ≤3, % | 10.6 | 10.0 |
5 min Apgar score ≤7, % | 15.0 | 15.2 |
Meconium Aspiration Syndrome, % | 1.8 | 1.5 |
2013 to 2015 N = 3,937 | 2017 N = 1,138 | RR (95% CI) | |
---|---|---|---|
Interventions | |||
Endotracheal suctioning, % | 57.0 | 28.9 | 0.51 (0.41–0.62) |
Conventional or high frequency ventilation, inhaled nitric oxide, or ECMO a, % | 42.3 | 40.3 | 0.95 (0.80–1.13) |
Conventional or high frequency ventilation, % | 41.8 | 40.2 | 0.96 (0.81–1.14) |
Inhaled nitric oxide, % | 12.1 | 13.7 | 1.13 (0.90–1.43) |
ECMO, % | 1.3 | 1.1 | 0.83 (0.41–1.68) |
Oxygen at any time, % | 92.6 | 90.0 | 0.97 (0.91–1.04) |
Surfactant at any time, % | 24.6 | 30.0 | 1.22 (1.01–1.48) |
Outcomes | |||
Death, % | 2.6 | 2.9 | 1.12 (0.74–1.69) |
Pneumothorax, % | 10.2 | 8.4 | 0.82 (0.63–1.08) |
Moderate/severe hypoxic-ischemic encephalopathy, % | 5.4 | 6.8 | 1.24 (0.91–1.69) |
Length of stay, days, median (q1, q3) | 8 (5, 16) | 8 (5, 17) | b |
2013 to 2015 N = 218,475 | 2017 N = 77,545 | RR (95% CI) | |
---|---|---|---|
Interventions | |||
Conventional or high frequency ventilation, inhaled nitric oxide, or ECMO a, % | 9.1 | 8.2 | 0.91 (0.87–0.95) |
Conventional or high frequency ventilation, % | 9.0 | 8.1 | 0.91 (0.87–0.95) |
Inhaled nitric oxide, % | 1.0 | 1.0 | 0.99 (0.90–1.09) |
ECMO, % | 0.3 | 0.2 | 0.91 (0.74–1.12) |
Oxygen at any time, % | 49.4 | 48.9 | 0.99 (0.97–1.01) |
Surfactant at any time, % | 3.8 | 3.5 | 0.93 (0.87–1.00) |
Outcomes | |||
Death, % | 1.1 | 1.1 | 1.01 (0.93–1.10) |
Pneumothorax, % | 3.5 | 3.3 | 0.93 (0.88–0.99) |
Moderate/severe hypoxic-ischemic encephalopathy, % | 0.6 | 0.7 | 1.14 (1.00–1.30) |
Length of stay, days, median (q1, q3) | 6 (4, 11) | 6 (4, 11) | b |
2013 to 2015 N = 1586 | 2017 N = 362 | RR (95% CI) | |
---|---|---|---|
Interventions | |||
Endotracheal suctioning, % | 82.4 | 52.1 | 0.63 (0.56, 0.71) |
Conventional or high frequency ventilation, inhaled nitric oxide, or ECMO a, % | 57.6 | 62.2 | 1.08 (0.97, 1.20) |
Conventional or high frequency ventilation, % | 57.4 | 61.9 | 1.08 (0.97, 1.20) |
Inhaled nitric oxide, % | 16.2 | 21.9 | 1.35 (1.08, 1.69) |
ECMO, % | 1.8 | 2.3 | 1.23 (0.47, 3.19) |
Oxygen at any time, % | 97.8 | 98.9 | 1.01 (0.99, 1.03) |
Surfactant at any time, % | 27.7 | 36.0 | 1.30 (1.09, 1.55) |
Outcomes | |||
Death, % | 5.3 | 7.2 | 1.38 (0.88, 2.16) |
Pneumothorax, % | 10.3 | 11.5 | 1.11 (0.80, 1.55) |
Moderate/severe hypoxic-ischemic encephalopathy, % | 12.1 | 20.1 | 1.67 (1.27, 2.19) |
Length of stay, days, median (q1, q3) | 9 (5, 17) | 10 (6, 20) | b |
2013 to 2015 N = 21,545 | 2017 N = 7,347 | RR (95% CI) | |
---|---|---|---|
Interventions | |||
Conventional or high frequency ventilation, inhaled nitric oxide, or ECMO a, % | 27.2 | 26.6 | 0.98 (0.93, 1.03) |
Conventional or high frequency ventilation, % | 27.1 | 26.6 | 0.98 (0.94, 1.03) |
Inhaled nitric oxide, % | 3.3 | 3.2 | 0.98 (0.86, 1.13) |
ECMO, % | 0.7 | 0.5 | 0.70 (0.49, 0.99) |
Oxygen at any time, % | 90.4 | 90.4 | 1.00 (0.99, 1.01) |
Surfactant at any time, % | 5.4 | 5.7 | 0.93 (0.87, 1.00) |
Outcomes | |||
Death, % | 5.6 | 5.7 | 1.02 (0.91, 1.14) |
Pneumothorax, % | 5.0 | 5.2 | 1.03 (0.91, 1.16) |
Moderate/severe hypoxic-ischemic encephalopathy, % | 5.5 | 6.8 | 1.25 (1.09, 1.42) |
Length of stay, days, median (q1, q3) | 6 (4, 11) | 6 (4, 11) | b |
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Edwards, E.M.; Lakshminrusimha, S.; Ehret, D.E.Y.; Horbar, J.D. NICU Admissions for Meconium Aspiration Syndrome before and after a National Resuscitation Program Suctioning Guideline Change. Children 2019, 6, 68. https://doi.org/10.3390/children6050068
Edwards EM, Lakshminrusimha S, Ehret DEY, Horbar JD. NICU Admissions for Meconium Aspiration Syndrome before and after a National Resuscitation Program Suctioning Guideline Change. Children. 2019; 6(5):68. https://doi.org/10.3390/children6050068
Chicago/Turabian StyleEdwards, Erika M., Satyan Lakshminrusimha, Danielle E. Y. Ehret, and Jeffrey D. Horbar. 2019. "NICU Admissions for Meconium Aspiration Syndrome before and after a National Resuscitation Program Suctioning Guideline Change" Children 6, no. 5: 68. https://doi.org/10.3390/children6050068
APA StyleEdwards, E. M., Lakshminrusimha, S., Ehret, D. E. Y., & Horbar, J. D. (2019). NICU Admissions for Meconium Aspiration Syndrome before and after a National Resuscitation Program Suctioning Guideline Change. Children, 6(5), 68. https://doi.org/10.3390/children6050068