The calculation of term-hospitalization for Low Birth Weight Infants in NICU The second report : Validity of curve regression for estimating hospital stay and clinical application <Original Articles>

本論文第一報にて我々はNICUに入院した低出生体重児の入院予測日数を2病院の出生体重と入院日数のデータをもとに指数関数の曲線回帰式から算出する方法を報告した. 本論文は①第一報で報告した回帰曲線の入院日数予測は, その後に入院した低出生体重の入院日数予測に実用可能だったか ②両病院NICUは移設・移転しており, そのことは入院予測日数に影響したか ③入院予測日数は両施設でどう異なるかを示し, 指数式回帰曲線からの入院日数予測の臨床応用において考慮する条件を検討するとともに, 施設毎に入院予測日数を算出する必要性を述べることを目的とした. 先行研究以後にNICUに入退院した低出生体重児N病院670人, R病院280人の出生体重と入院日数のデータからPASW.18により指数方程式による回帰曲線を出力させ入院予測日数をもとめた. N病院では先行研究の入院予測日数の回帰曲線は今研究のNICUに入院した低出生体重児の指数モデルの回帰曲線とほとんど変わらず, 先行研究の入院日数予測はその後入院した低出生体重児の入院予測として実用可能であった. また先行研究以後の入院予測日数の回帰曲線は移設前後でほぼ等しく, 移設の影響はほとんど見られなかった. 一方, R病院では先行研究と移転後の回帰曲線は大きく異なり, 先行研究の入院予測は移転後の入院日数予測には適応できなかった. また, 移転後も入院予測日数の回帰曲線はまだ変動がみられ, 臨床応用するには今後も入院予測日数の見直しが必要であることを示唆した. N病院とR病院の回帰曲線は異なっていたことから, 各施設で回帰曲線を作成し入院予測日数を求めることが正確なクリティカルパス作成につながる.We reported a method to calculate and predict hospitalization period of the low birth weight infants in two NICU using a curve regression of exponential equation based on the data of birth weight and the hospitalization days by the first report. The purpose of this study is whether the estimated hospitalization period of the regression curve was practical and possible to calculate the hospitalization days of the LBWI who had been hospitalized afterwards. The subjects were 670 and 280 infants with a birth weight less than 2500 g and admitted to NICU within 0-2 days after birth, in N hospital and R hospital. Data of hospital stay, birth weight and gestational age at birth were collected and conducted to statistical analyses using PASW Statistics 18. NICU stay days' plots against birth weight fitted the exponential function well, and the obtained regression curve formula and the parameters showed the estimated hospitalization period by birth weight. In N hospital, the regression curve of the estimated hospitalization period by the previous work was similar to the regression curve of this research. It was suggested the estimated hospitalization period of the previous work be adjusted to the hospitalization of LBWI who had been hospitalized afterwards. Moreover, the regression curve was almost equal before and after the transfer of hospital, and it means the transfer was little influence in hospitalization days. In R hospital, regression curve of the previous work and the present study is fairly different, and it was suggested the estimated hospitalization period of the previous work has clearly indicated no adjustment after transfer hospital. Since regression curve of estimated hospitalization period of LBWI was different between N and R hospitals; and request for making the regression curve in each facility could make an accurate critical path. The calculation hospitalization period by the regression curve may alleviate the anxiety of the infant's mothers and family. Moreover it may be utilized for evaluation of nursing care

The calculation of term-hospitalization for Low birth weight infant in NICU

低出生体重児の入院期間の予測は,母親をはじめ家族に安心感をもたらすとともに,治療・ケア計画に役立ち,評価や業務改善につながるという前提のもとに,入院時点に最も確実に把握可能な出生体重及び在胎日数を変数として入院日数との関係を統計分析し,入院日数の予測が可能かどうかを検討した.沖縄県のNICUを有する国公立の2病院において,生後0～3日以内にNICUに入院した2500g未満の入院児それぞれ209人,295人について入院期間,出生週数,出生体重を調べその統計分析を試みた。その結果,低出生体重児の出生体重と入院期間には高い有意の相関があり,それは在胎日数と入院期間の関係より高い相関であった.また直線式より指数式によく当てはまった.このことは出生体重を,指数式に当てはめることで入院期間をある程度,推測することが可能であることを示唆している.このことから各施設のNICUの低体出生東児の入院日数は,児の出生体重と入院期間のデータから指数式の係数を求めて曲線式に当てはめ一覧表を作成することで予測できると考える.看護者はこの一覧表と照らし合わせることで,早産で生まれた合併症の少ない児に対しては,出生体重のみから入院早期に,ある程度の入院日数を予測することができる.その入院予測日数を基に退院予定日からさかのぼってケア計画を立てることができ,母親や家族の不安軽減や,退院準備に役立てるとともに看護ケアの評価にも活用できると考える.Predicting the hospitalization period for low-birth-weight infants is may help the infant's mother and other family members reduce their anxiety, and to be useful in devising a treatment and care plan, leading to better evaluation of care. Under this expectation, this study was undertaken to statistically analyze the relationship of hospitalization period to two variables (birth weight and intrauterine period expressed in days) , because the data are most reliably available at the time of admission to NICU. At 2 hospitals in Okinawa Prefecture (a national hospital and a public hospital) , data on hospital stay period, gestational age at birth (the intrauterine period) and birth weight were collected from 211 and 297 infants who were admitted to the NICU of these two hospitals within 0-3 days after birth with a weight less than 2500 g. The statistically significant correlation was noted between the birth weight and the hospitalization period of low-birth-weight infants, and its correlation was higher than the gestational age at birth. We obtained exponential regression curve formula respectively. The formula were Y1=316.452 × e-0.0017 × W and Y2=288.791 × e-0.0012 × W, where e is the base on Nepierian logarithms ;2.718 and W is birth weight. The hospitalization period of low-birth-weight infant was born without major complications can be predicted from a table that is prepared by applying to these formulas. By comparing the birth weight of a given infant to this table, the nurse can predict the hospitalization period of the infant relatively accurately soon after admission on the basis of birth weight alone. If the hospitalization period can be predicted in this way, the medical staff can devise a treatment and care plan towards the predicted discharge day. The predicted stay period can also be utilized to alleviate the anxiety of the infant's mother and other family members and to allow the infant's family to prepare for discharge. Furthermore, the predicted hospitalization period may also be utilized for ..