Outcomes of Neonates With Complex Medical Needs.
British Columbia
/ epidemiology
Cohort Studies
Comorbidity
Congenital Abnormalities
/ epidemiology
Gestational Age
Humans
Infant, Extremely Premature
Infant, Newborn
Infant, Newborn, Diseases
Intensive Care, Neonatal
/ methods
Nervous System Malformations
/ epidemiology
Outcome Assessment, Health Care
Patient Discharge
/ statistics & numerical data
Retrospective Studies
Treatment Outcome
Journal
Advances in neonatal care : official journal of the National Association of Neonatal Nurses
ISSN: 1536-0911
Titre abrégé: Adv Neonatal Care
Pays: United States
ID NLM: 101125644
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
pubmed:
4
7
2019
medline:
6
2
2020
entrez:
4
7
2019
Statut:
ppublish
Résumé
Children with complex medical needs (CMN) are high healthcare resource utilizers, have varying underlying diagnoses, and experience repeated hospitalizations. Outcomes on neonatal intensive care (NICU) patients with CMN are unknown. The primary aim is to describe the clinical profile, resource use, prevalence, and both in-hospital and postdischarge outcomes of neonates with CMN. The secondary aim is to assess the feasibility of sustaining the use of the neonatal complex care team (NCCT). A retrospective cohort study was conducted after implementing a new model of care for neonates with CMN in the NICU. All neonates born between January 2013 and December 2016 and who met the criteria for CMN and were cared for by the NCCT were included. One hundred forty-seven neonates with a mean (standard deviation) gestational age of 34 (5) weeks were included. The major underlying diagnoses were genetic/chromosomal abnormalities (48%), extreme prematurity (26%), neurological abnormality (12%), and congenital anomalies (11%). Interventions received included mechanical ventilation (69%), parenteral nutrition (68%), and technology dependency at discharge (91%). Mortality was 3% before discharge and 17% after discharge. Postdischarge hospital attendances included emergency department visits (44%) and inpatient admissions (58%), which involved pediatric intensive care unit admissions (26%). Neonates with CMN have multiple comorbidities, high resource needs, significant postdischarge mortality, and rehospitalization rates. These cohorts of NICU patients can be identified early during their NICU course and serve as targets for implementing innovative care models to meet their unique needs. Future studies should explore the feasibility of implementing innovative care models and their potential impact on patient outcomes and cost-effectiveness.
Sections du résumé
BACKGROUND
BACKGROUND
Children with complex medical needs (CMN) are high healthcare resource utilizers, have varying underlying diagnoses, and experience repeated hospitalizations. Outcomes on neonatal intensive care (NICU) patients with CMN are unknown.
PURPOSE
OBJECTIVE
The primary aim is to describe the clinical profile, resource use, prevalence, and both in-hospital and postdischarge outcomes of neonates with CMN. The secondary aim is to assess the feasibility of sustaining the use of the neonatal complex care team (NCCT).
METHODS
METHODS
A retrospective cohort study was conducted after implementing a new model of care for neonates with CMN in the NICU. All neonates born between January 2013 and December 2016 and who met the criteria for CMN and were cared for by the NCCT were included.
RESULTS
RESULTS
One hundred forty-seven neonates with a mean (standard deviation) gestational age of 34 (5) weeks were included. The major underlying diagnoses were genetic/chromosomal abnormalities (48%), extreme prematurity (26%), neurological abnormality (12%), and congenital anomalies (11%). Interventions received included mechanical ventilation (69%), parenteral nutrition (68%), and technology dependency at discharge (91%). Mortality was 3% before discharge and 17% after discharge. Postdischarge hospital attendances included emergency department visits (44%) and inpatient admissions (58%), which involved pediatric intensive care unit admissions (26%).
IMPLICATIONS FOR PRACTICE
CONCLUSIONS
Neonates with CMN have multiple comorbidities, high resource needs, significant postdischarge mortality, and rehospitalization rates. These cohorts of NICU patients can be identified early during their NICU course and serve as targets for implementing innovative care models to meet their unique needs.
IMPLICATIONS FOR RESEARCH
CONCLUSIONS
Future studies should explore the feasibility of implementing innovative care models and their potential impact on patient outcomes and cost-effectiveness.
Identifiants
pubmed: 31268866
doi: 10.1097/ANC.0000000000000639
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM