THE IMPACT OF DAY-CARE ON VENTILATION TUBE INSERTION

Objective: To study the effect of day care and tube type, as well as o ther risk factors related to ventilation tube insertion and reinsertio n. Design: A case series of 456 consecutive cases with 162 controls fr om a well-baby examination group evaluated for age, sex, smoking histo ry and day care attendance. Setting: Private practice in a mid-sized, southeastern university town. Patients and controls: This was a referr ed sample of patients who were entered consecutively in a private-prac tice setting. All children were ape five or less at entry into the stu dy. Interventions: Children underwent ventilation tube insertion with or without adenoidectomy, using standing indications. Main outcome mea sures: The primary outcome measures were whether or not a child had th e need for a second set of tubes, and also determining the status of t he child's ears for at least 1 year after tubes had extruded. Results: Day care and younger age were both identified as risk factors associa ted with initial ventilation tube insertion. Only 11%(seven out of 63) of home care children, as compared with 31% (108 out of 346) day care children, had the insertion of ventilation tubes (P = 0.000). Day car e children who had tubes inserted and adenoidectomy (with or without t onsillectomy) had a significantly lower rate of reintubation than chil dren who had tube insertion alone (P = 0.00). Day care and young age a re significant risk factors for any child, both with a first set of tu bes and for ventilation tube reinsertion. Children in day care had a r eintubation rate of 36% as compared to 11% for those in home care. Par ents should be aware that day care can represent a two-fold hazard bot h in the observed connection between day care and tube insertion and t he demonstrated increased probability of reinsertion. Any studies look ing at ventilation tube outcomes need to make certain to monitor for d ay care attendance. (C) 1997 Elsevier Science Ireland Ltd.