Convalescent Care of Infants in the Neonatal Intensive Care Unit in Community Hospitals: Risk or Benefit?
Convalescent Care of Infants in the Neonatal Intensive Care Unit in Community Hospitals: Risk or Benefit?
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DOI：
10.1542/peds.2008-0880
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发表时间：
2009-07-01
期刊：
影响因子：
8
通讯作者：
Aucott, Susan W.
中科院分区：
文献类型：
--
作者：
Donohue, Pamela K.;Hussey-Gardner, Brenda;Aucott, Susan W.
目的：比较出院前送往社区医院(CH)的极低出生体重儿(VLBW)和在区域转诊NICU(RR-NICU)接受康复护理的婴儿在出院时的健康指标、出院后4个月内的卫生保健利用、父母对医院护理的满意度和住院费用4个参数。一个RR-NICU将婴儿转移到CH进行康复护理，另一个直接将婴儿送回家。对婴儿进行前瞻性跟踪调查。从病历、家长访谈和医院业务办公室收集信息。结果：共有255名极低出生体重儿参加研究，其中148人被转移到15家社区卫生服务机构。19%的转院婴儿在出院前重新入院接受更高级别的护理。预防健康措施和筛查检查更经常被遗漏，出院后2周内再次入院的频率更高，父母对医院护理不太满意，住院时间延长了12天，尽管在统计学上没有差异，但如果婴儿被转移到CH疗养而不是从RR-NICU出院。两组间的总住院费用没有显著差异。结论：将婴儿从RR-NICU转到CH进行康复护理已成为惯例，但可能会将婴儿置于危险之中。我们的研究表明，CHS和RR-NICU在护理转运的极低出生体重儿方面都有改进的空间。儿科2009；124：105-111
OBJECTIVE: To compare very low birth weight (VLBW) infants transported to a community hospital (CH) before discharge with infants who received convalescent care in a regional-referral NICU (RR-NICU) on 4 parameters: health indicators at the time of hospital discharge, health care use during the 4 months after discharge to home, parent satisfaction with hospital care, and cost of hospitalization.PATIENTS AND METHODS: VLBW infants cared for in 2 RR-NICUs during 2004-2006 were enrolled in the study. One RR-NICU transfers infants to a CH for convalescent care and the other discharges infants directly home. Infants were followed prospectively. Information was gathered from medical charts, parent interviews, and hospital business offices.RESULTS: A total of 255 VLBW infants were enrolled in the study, and 148 were transferred to 15 CHs. Nineteen percent of transferred infants were readmitted to a higher level of care before discharge from the hospital. Preventative health measures and screening examinations were more frequently missed, readmission within 2 weeks of discharge from the hospital was more frequent, parents were less satisfied with hospital care, and duration of hospitalization was 12 days longer, although not statistically different, if infants were transferred to a CH for convalescence rather than discharged from the RR-NICU. Total hospital charges did not differ significantly between the groups.CONCLUSION: 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. Pediatrics 2009;124:105-111