Convalescent Care of Infants in the Neonatal Intensive Care Unit in Community Hospitals: Risk or Benefit?

Donohue, Pamela; Hussey-Gardner, Brenda; Sulpar, Leslie J.; Fox, Renee E.; Aucott, Susan W.

doi:10.1542/peds.2008-0880

Cited by 21 publications

(27 citation statements)

References 10 publications

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“…In contrast to this infant, out-born infants were returned to their original referring hospital or clinic after shorter lengths of stay because we actively promoted family bonding for infants who are not seriously ill. Despite the benefits of convalescent transport, changes in setting or caretakers, or increased risk associated with rehospitalization resulted in increased parental anxiety 7,8 . Fortunately, there was no unplanned rehospitalizations or emergency room visits before first scheduled clinic follow-up after home 8 discharge.…”

Section: Discussionmentioning

confidence: 99%

Interfacility Neonatal Transport for Convalescent Care: Improving Regionalized Care

et al. 2020

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Background: Transfer of infants who no longer need intensive or specialized care from tertiary to community hospitals or clinics contributes to efficient bed utilization in neonatal intensive care units (NICUs). Methods: A retrospective analysis of the records of all 1,503 infants admitted to our NICU during the past 6 years (from April 2013 to March 2019) was performed to evaluate the impact of interfacility neonatal transport for convalescent care. Results: During the study period, our NICU accepted 33 infants from other tertiary NICUs and transferred 103 infants to other hospitals or clinics before their home discharge for convalescent care. Our NICU covered 39% of the total hospital days of infants accepted from other NICUs. Of the infants transferred to other facilities, 81% of infants born at our hospital were born to mothers transported to our obstetric department as imminent high-risk deliveries; 94% of infants born at other hospitals were moved back to the referring facility. Conclusions: Interfacility neonatal transport for, both accepting and transferring infants for convalescent care has become an integral part of NICU practice to bridge the gaps between higher level care facility and home. Establishment of well-defined transfer criteria and appropriate allocation of medical and staff resources among relevant facilities is desirable.

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Section: Discussionmentioning

confidence: 99%

Interfacility Neonatal Transport for Convalescent Care: Improving Regionalized Care

et al. 2020

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“…Identifying patients at low risk of CHD is needed to develop algorithms to avoid unnecessary costs of care, delay of surgical intervention, and to minimize risk of inadequate evaluation. This may diminish NICU costs, which average more than $1,400 per day and reduce the incremental cost of routine screening echocardiogram [8, 12]. …”

Section: Discussionmentioning

confidence: 99%

Is routine preoperative screening echocardiogram indicated in all children with congenital duodenal obstruction?

et al. 2014

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Introduction Congenital duodenal obstruction (DO) is frequently associated with congenital heart disease (CHD). Operative repair of DO is often postponed until an echocardiogram is completed, which may result in unnecessary delays. We aimed to identify and characterize CHD in children with DO to determine if appropriately selected patients could forego preoperative echocardiogram. Methods A two-center retrospective review of all infants with DO undergoing operative repair with completed echocardiograms was included (2003–2011). Demographics, co-morbid conditions, clinical exam findings, radiologic imaging, and need for cardiac surgery were recorded. Results 67 children were identified. 47 (70.1 %) had CHD on echocardiogram of which 19 (40.5 %) had significant CHD. Children without clinical findings, abnormalities on physical examination, and/or abnormal chest x-ray were unlikely to have CHD; i.e., no asymptomatic child had significant CHD. Sensitivity and specificity of clinical findings, physical exam, and/or chest x-ray for significant CHD were 100 % (95 % CI 0.79–1.0) and 37.5 % (95 % CI 0.24–0.53), respectively, for major CHD and 87.2 % (0.74–0.95) and 60 % (0.36–0.80) for any CHD. Conclusion Careful clinical assessment, evaluation with pulse oximetry, and chest x-ray may be sufficient to exclude significant CHD in children with DO. Identifying children at low risk for cardiac lesions may prevent unnecessary delays to operative intervention and may limit medical expenses.

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“…These results differ from our earlier report, which shows that the parents of transferred infants are less satisfied with hospital care at a CH than at a RR-NICU. 18 The reason for this difference may be that parents perceive medical care differently than discharge planning, or that a single summary question to measure satisfaction with the discharge process and feelings of preparedness may be too global for detecting differences between the groups. Parents may also view the transfer and strengths and weaknesses of the discharge process differently after some time at home; exploring parents' perceptions after a period of reflection would be valuable for quality improvement initiatives.…”

Section: Discussionmentioning

confidence: 99%

Parents' perception of the back-transport of very-low-birth-weight infants to community hospitals

et al. 2009

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Objective: To characterize parents' perception of back-transport of verylow-birth-weight (VLBW) infants from a regional referral neonatal intensive care unit (RR-NICU) to a community hospital (CH) for convalescent care.Study Design: Mixed methods utilizing parental interview and medical record review.Result: Overall, 20% of parents selected the CH to which their child was transferred. Less than half of the parents wanted the transfer. Psychological comfort with the RR-NICU was the most frequently reported reason for opposing transfer. At the time of home discharge, most parents were satisfied with the transfer and felt prepared to care for their infant at home. Conclusion:Parents want their infants closer to home, but are worried about the unknown. They are willing to forfeit autonomy in decisionmaking regarding the site of convalescent care. Parents need better preparation for transfer. Including them in an advisory group that reviews transfer policies could ameliorate the transition.

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Convalescent Care of Infants in the Neonatal Intensive Care Unit in Community Hospitals: Risk or Benefit?

Abstract: Transfer of infants to a CH from an RR-NICU for convalescent care has become routine but may place infants at risk. Our study indicates room for improvement by both CHs and RR-NICUs in the care of transferred VLBW infants.

Cited by 21 publications

References 10 publications

Interfacility Neonatal Transport for Convalescent Care: Improving Regionalized Care

Interfacility Neonatal Transport for Convalescent Care: Improving Regionalized Care

Is routine preoperative screening echocardiogram indicated in all children with congenital duodenal obstruction?

Parents' perception of the back-transport of very-low-birth-weight infants to community hospitals

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