UNSTUDIED INFANTS: LOW RISK BABIES IN A HIGH RISK PLACE

虽然新生儿重症监护对极低出生体重早产儿的有效性得到了广泛认可，但大多数新生儿重症监护实际上是为低风险患者提供的，预期结果良好。 很少有文献描述这些患者的特征，证据表明临床实践中存在巨大差异。 本研究将研究低风险新生儿重症监护室（NICU）人群，这些人群在关注极早产、死亡率和高科技方面被“遗忘”，特别是中度早产儿（孕龄30-35周[GA]），他们需要有限的技术支持来保暖，提供营养和监测，直到他们足够成熟，可以安全出院。 使用异质样本的12个新生儿重症监护病房和“中间护理”托儿所在加州和马萨诸塞州，我们将描述的患病率，过程和结果的照顾，这“健康早产儿”的人口构成的30- 50%的新生儿重症监护病房入院和卧床天数。 我们将特别强调测量1）控制基线风险后结局的变化，包括测量的生理疾病严重程度，2）母亲种族，年龄和保险状况的影响，以及3）影响ICU资源利用的区域和组织方面。 该研究将包括每家医院的一年出生队列，按比例随机抽样低风险提前出院（30-34 6/7周GA），旨在每家医院获得100例。 我们将结合使用电子出生记录、新生儿重症监护入院的前瞻性日志、医疗记录审查和3个月时的后续父母访谈（以英语和西班牙语提供）。 分析将包括再入院、住院时间、资源使用和父母满意度的预测模型。 结果将确定具有更好结果的站点以及与之相关的实践。 这些结果代表了在当前技术范围内完全可以实现的目标。

While the effectiveness of neonatal intensive care for very low birth weight premature babies is widely recognized, the majority of neonatal intensive care is actually rendered to low risk patients with excellent expected outcomes. Little literature is available to characterize such patients, and evidence suggests enormous variations in clinical practice. This investigation will study a low risk Neonatal Intensive Care Unit (NICU) populations that has been "forgotten" in the focus on extreme prematurity, mortality and high technology, specifically, moderately premature infants (30-35 weeks gestation age [GA]) who need limited technologic support to stay warm and provide nourishment and monitoring until they are mature enough to discharge safely. Using a heterogeneous sample of 12 NICUs and "intermediate care" nurseries in California and Massachusetts, we will characterize the prevalence, process and outcome of care of this "healthy preemie" population which constitutes 30-50 percent of all NICU admissions and bed-days. We will place special emphasis on measuring 1) variation in outcomes after controlling for baseline risk, including measured physiologic illness severity, 2) the effects of maternal race, age, and insurance status, and 3) regional and organizational aspects that affect utilization of ICU resources. The study will consist of a one year birth cohort at each hospital, with proportionate random sampling of the low-risk premature discharges (30-34 6/7 weeks GA) designed to obtain 100 per hospital. We will use a combination of electronic birth records, a prospective log of neonatal intensive care admissions, medical records review and follow-up parental interviews at 3 months (given in both English and Spanish). Analyses will include predictive models for readmission, length of stay, resource use and parental satisfaction. Results will identify sites with better outcomes and the practices associated with them. These outcomes represent achievable goals well within the scope of current technology.