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提供给具有良好预期结果的低风险患者。很少有文献可以描述这些患者的特征，而且有证据表明，在临床实践中存在巨大的差异。这项调查将研究低风险新生儿重症监护病房(NICU)人群，这些人群在关注极端早产儿、死亡率和高科技方面已被“遗忘”，特别是中早产儿(孕龄30-35周)，他们需要有限的技术支持来保暖，并提供营养和监测，直到他们成熟到足以安全出院。利用加利福尼亚州和马萨诸塞州的12个NICU和“中间护理”托儿所的不同样本，我们将描述占所有NICU入院人数和卧床天数的30%-50%的“健康早产儿”群体的患病率、护理过程和护理结果。我们将特别强调衡量1)在控制基线风险后结局的变化，包括测量的生理性疾病严重性，2)母亲种族、年龄和保险状况的影响，以及3)影响ICU资源利用的地区和组织方面。这项研究将包括在每家医院进行一年的出生队列，对低风险的过早出院(30-34 6/7周GA)按比例随机抽样，以使每家医院获得100例。我们将结合使用电子出生记录、新生儿重症监护入院预期记录、医疗记录审查和3个月后的后续父母访谈(以英语和西班牙语给出)。分析将包括对重新入院、住院时间、资源使用和父母满意度的预测模型。结果将确定结果更好的地点和与之相关的做法。这些成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.