RESUMEN
INTRODUCTION: In a regionalized perinatal system, recovering neonates may be back transported from a regional Neonatal Intensive Care Unit (NICU) to community hospitals closer to their residence to convalesce prior to hospital discharge. OBJECTIVE: This study evaluates the practice of neonatal back transport for growth and the duration of total hospitalization. METHODS: We conducted a retrospective study comparing length of stay (LOS) for infants back transported from a regional NICU to a level II nursery for convalescent care (BT), with LOS for infants eligible for back transport discharged home from the Regional Center (RC). RESULTS: A total of 221 infants were studied. BT infants (n=104) had lower birth weights (median; 1955 vs 2700 g, p=0.001), more frequently needed mechanical ventilation (84 vs 65%, p=0.002) and parenteral nutrition (71 vs 55%, p=0.013), less frequently were evaluated by subspecialists (20 vs 59% p=0.0001), and had longer total LOS (median; 20 vs 11 days, p<0.0001) compared to infants discharged home from the RC (n=117). However, in the subgroup with birth weights Asunto(s)
Hospitales Comunitarios/estadística & datos numéricos
, Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos
, Tiempo de Internación/estadística & datos numéricos
, Salas Cuna en Hospital/estadística & datos numéricos
, Evaluación de Procesos y Resultados en Atención de Salud
, Readmisión del Paciente/estadística & datos numéricos
, Transferencia de Pacientes/estadística & datos numéricos
, Peso al Nacer
, Convalecencia
, Humanos
, Recién Nacido
, Recien Nacido Prematuro
, Michigan
, Nutrición Parenteral Total
, Programas Médicos Regionales
, Respiración Artificial
, Estudios Retrospectivos
RESUMEN
OBJECTIVE: To assess neonatal intensive care unit (NICU) practices affecting screening and follow-up for retinopathy of prematurity (ROP). METHODS: Retrospective study of infants at risk for ROP, eligible for back transport, admitted to a regional NICU from January 1, 1999 until May 31, 2002. Patients failed to receive needed follow-up for ROP after discharge or transfer from a NICU, if we could not verify their ROP screening follow-up within 1 month. RESULTS: A total of 74 infants were identified to need follow-up eye care. Infants who did not receive the follow-up care had greater mean gestational age (mean SD; 30.7+/-2.3 vs 29.6+/-2.5 weeks, p=0.05) and birth weights (mean SD; 1581+/-366 vs 1360+/-508 g, p=0.007), compared to infants who received the recommended care. Infants transported back to the community hospital were significantly more likely to miss follow-up eye care compared to infants discharged from the regional center (relative risk 2.81, 95% confidence interval (CI) (1.09 to 7.20)). Infants not screened for ROP in the NICU had greater risk for missing follow-up care compared to infants who had their first retinal examination in the NICU (relative risk 4.25, 95% CI (1.42 to 12.73)). CONCLUSIONS: Infants transferred back or discharged from the NICU before ROP screening represent a high-risk group for not receiving follow-up eye care.