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广泛认可，但大多数新生儿重症监护实际上是对低风险患者进行的，预期结果良好。很少有文献可以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病房（NICU）人群，这些人群在极度早产、死亡率和高科技的关注中被“遗忘”，特别是中度早产儿（30-35周孕龄[GA]），他们需要有限的技术支持来保暖、提供营养和监测，直到他们成熟到足以安全出院。使用加利福尼亚和马萨诸塞州的12个新生儿重症监护病房和“中间护理”托儿所的异质样本，我们将描述这些“健康早产儿”人群的患病率、护理过程和结果，这些人群占所有新生儿重症监护病房入院和住院天数的30- 50%。我们将特别强调测量1)控制基线风险后结果的变化，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。该研究将包括在每家医院进行为期一年的出生队列，按比例随机抽样低风险早产（30-34 6/7周出生），每家医院设计为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、医疗记录回顾和3个月时的随访父母访谈（以英语和西班牙语提供）。分析将包括再入院、住院时间、资源利用和父母满意度的预测模型。结果将确定具有较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.