UNSTUDIED INFANTS: LOW RISK BABIES IN A HIGH RISK PLACE

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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.