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Welke N, Lagatta J, Leuthner S, Acharya K. Three-Year Post-Neonatal Intensive Care Unit Health Care Utilization Among Infants with Congenital Anomalies. J Pediatr 2024; 265:113779. [PMID: 37852433 DOI: 10.1016/j.jpeds.2023.113779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To describe 3-year post-neonatal intensive care unit (NICU) health care use among children with congenital anomalies discharged home from a level IV NICU. STUDY DESIGN Retrospective chart review of children with congenital anomalies enrolled in a previous prospective cohort study from 201 to 2020. We assessed hospital readmission rate, number of surgeries, and durable medical equipment (DME) use by type of anomaly. RESULTS Among 166 infants enrolled in the original study, 158 survived to NICU discharge. One-third of the cohort had a genetic anomaly. Six of 158 patients (4%) died before 3 years of age. More than one-half the children were readmitted within the first 2 years of life, and one-third were readmitted in the third year of life. Readmissions were greatest for those with multiple, musculoskeletal, and central nervous system anomalies and lowest for abdominal-wall defects. Approximately one-half the children underwent surgeries, and this proportion remained constant over the 3-year time. Sixty-two percent of patients received DME at discharge, with gastrostomy tubes being the most common. Gastrostomy tubes were still present in 75% of the patients at 3 years of age. CONCLUSION Children with congenital anomalies are at risk for increased health care use during early childhood. Those with multiple anomalies, a genetic syndrome, musculoskeletal, and central nervous system anomalies and those discharged with DME are at greatest risk whereas those with abdominal-wall defects are at lowest risk. Provider awareness, high-quality discharge training, parent psychological support, greater assimilation of families in the NICU, and telehealth may be some strategies to better support these families.
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Affiliation(s)
- Nicole Welke
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Joanne Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Steven Leuthner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Krishna Acharya
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
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Hua W, Zhou J, Wang L, Li C, Zheng Q, Yuwen W, Jiang L. 'It turned my life upside down': Parents' emotional experience of the transition with their preterm infant from birth to discharge Home-A qualitative study. Aust Crit Care 2023; 36:679-686. [PMID: 36464525 DOI: 10.1016/j.aucc.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND A smooth transition from the neonatal intensive care unit (NICU) to home is critical for establishing parents' competence as primary caregivers and ensuring infant health. In the clinical context with a restrictive visiting policy, family-centred care is challenging to implement, prohibiting a smooth transition of care for the families. According to Meleis' Transition Theory, parents might experience emotional change initiated by critical events during this transition. OBJECTIVES The aim of this study was to understand parents' emotional experience of their preterm infant's birth to discharge home from the NICU to facilitate the care transition better. METHODS This qualitative descriptive study using semistructured interviews was conducted between June and August 2020. Purposive sampling was used to recruit 17 parents (6 fathers and 11 mothers) from the NICU of a tertiary hospital in eastern China. Data were analysed using content analysis. RESULTS The following three situational themes characterised by three-phase emotions related to 16 critical events were obtained from the data and were used to describe parents' experiences during the transition: Theme 1, Life falling apart; Theme 2, Feeling anxious and struggling with uncertainty; and Theme 3, Feeling both hopeful and inadequate at discharge. CONCLUSIONS Parents of preterm infants have distinctive emotional experiences in each phase during their infants' transition from the NICU to home. Awareness of parents' critical events and emotional experiences in each phase could help NICU staff anticipate and provide timely and targeted support for parents. The next step is to develop a family-centred intervention for healthcare providers to better prepare parents for the transition from the NICU to home.
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Affiliation(s)
- Wenzhe Hua
- Shanghai Jiao Tong University School of Nursing, 227 Chongqing Road, Shanghai, 200025, PR China
| | - Jingxin Zhou
- Department of Neonatology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, PR China
| | - Liying Wang
- Department of Psychology, University of Washington, 3920 15th Ave NE, Seattle, WA, 98195, USA
| | - Chenxing Li
- Department of Psychology, University of Washington, 3920 15th Ave NE, Seattle, WA, 98195, USA
| | - Qiaomu Zheng
- Shanghai Jiao Tong University School of Nursing, 227 Chongqing Road, Shanghai, 200025, PR China
| | - Weichao Yuwen
- School of Nursing and Healthcare Leadership, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Liping Jiang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, 200092, Shanghai, PR China.
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Very-low-birth-weight infant short-term post-discharge outcomes: A retrospective study of specialized compared to standard care. Matern Child Health J 2023; 27:487-496. [PMID: 36588143 DOI: 10.1007/s10995-022-03517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Ongoing health care challenges, low breast milk intake, and the need for rehospitalization are common during the first year of life after hospital discharge for very low birth weight (VLBW) infants. This retrospective cohort study examined breast milk intake, growth, emergency department (ED) visits, and non-surgical rehospitalizations for VLBW infants who received specialized post-discharge follow-up in western Canada, compared to VLBW infants who received standard follow-up in central Canada. DESIGN Data were collected from two neonatal follow-up programs for VLBW babies (n = 150 specialized-care; n = 205 standard-care). Logistic regression was used to examine odds of breast milk intake and generalized estimating equations were used for odds of growth, ED visits and non-surgical rehospitalization by site. RESULTS Specialized-care was associated with enhanced breast milk intake duration; the odds of receiving breastmilk at 4 months in the specialized-care cohort was 6 times that in the standard-care cohort. The specialized-care cohort had significantly more ED visits and rehospitalizations. However, for infants with oxygen use beyond 36 weeks compared to those with no oxygen use, the standard-care cohort had over 7 times the odds of rehospitalization where as the specialized-care cohort with no increased odds of rehospitalization. CONCLUSION Specialized neonatal nursing follow-up was associated with continued breastmilk intake beyond discharge. Infants in the specialized-care cohort used the ED and were hospitalized more often than the standard-care cohort with the exception of infants with long term oxygen needs.
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Hebballi NB, Avritscher EBC, Garcia E, Bain A, Bartz-Kurycki MA, Tsao K, Austin MT. Healthcare Utilization Among Infants Discharged From the Neonatal Intensive Care Unit: A Descriptive Cost Analysis. Health Serv Insights 2023; 16:11786329231169604. [PMID: 37114206 PMCID: PMC10126788 DOI: 10.1177/11786329231169604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
The cost of readmissions of neonatal intensive care unit (NICU) graduates within 6 months and a year of their life is well-studied. However, the cost of readmissions within 90 days of NICU discharge is unknown. This study's objective was to estimate the overall and mean cost of healthcare use for unplanned hospital visits of NICU graduates within 90 days of discharge A retrospective review of all infants discharged between 1/1/2017 and 03/31/2017 from a large hospital system NICUs was conducted. All unplanned hospital visits (readmissions or stand-alone emergency department (ED) visits) occurring within 90 days post NICU discharge were included. The total and mean cost of unplanned hospital visits were computed and adjusted to 2021 US dollars. The total cost was estimated to be $785 804 with a mean of $1898 per patient. Hospital readmissions accounted for 98% ($768 718) of the total costs and ED visits for 2% ($17 086). The mean cost per readmission and stand-alone ED visit were $25 624 and $475 respectively. The highest mean total cost of unplanned hospital readmission was noted in extremely low birth weight infants ($25 295). Interventions targeted to reduce hospital readmissions after NICU discharge have the potential to significantly reduce healthcare costs for this patient population.
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Affiliation(s)
- Nutan B Hebballi
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
- Nutan B Hebballi, Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin Street, Suite 471, Houston, TX 77030, USA.
| | - Elenir BC Avritscher
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Elisa Garcia
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Andrew Bain
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Marisa A Bartz-Kurycki
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - KuoJen Tsao
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
- Children’s Memorial Hermann Hospital, Houston, TX, USA
| | - Mary T Austin
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
- Children’s Memorial Hermann Hospital, Houston, TX, USA
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Abstract
BACKGROUND A successful transition from the neonatal intensive care unit to home is fundamental for the long-term health and well-being of preterm infants; however, the process parents' experience during their transition home is poorly understood. An improved understanding of this concept will allow nurses to offer families comprehensive and collaborative discharge preparation. PURPOSE To describe the defining attributes, antecedents, and consequences for the concept of transition in the context of the neonatal intensive care unit to home. METHODS Databases, MEDLINE, CINAHL, PsycINFO, and EMBASE were searched for articles containing "transition" in combination with "neonatal intensive care unit" or variants of these terms. The Walker and Avant method was used for this concept analysis. RESULTS The defining attributes of transition in the context of the neonatal intensive care unit to home are "mix of emotions," "uncertainty," and "coming into parenthood." The principal antecedent is "hospital discharge preparation" and consequences include "feeding and medical needs," "family life changes," and "parental confidence." IMPLICATIONS FOR PRACTICE Gradually increasing parents' participation in their infant's care and forming a partnership and collaborative plan with families will help ease the uncertainty parents experience during their transition home. IMPLICATIONS FOR RESEARCH Further investigation is needed to determine how best to provide emotional support for parents during their transition home and to explore a feasible option for neonatal nurses to follow up with parents after hospital discharge.
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Barriers to Transition to Home From the Neonatal Intensive Care Unit: A Qualitative Perspectives of Parents and Healthcare Providers. J Perinat Neonatal Nurs 2021; 35:340-349. [PMID: 34726651 DOI: 10.1097/jpn.0000000000000570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The objective of this study was to explore the challenges faced by parents of former neonatal intensive care unit (NICU) patients in transitioning home from parents' and healthcare providers' perspective. We conducted semistructured individual and group interviews with parents of former NICU patients and healthcare providers. Themes from the individual interviews framed the group interviews' contents. The group interviews were recorded and transcribed, and thematic analysis was performed to identify themes. We conducted individual and group interviews with 16 parents and 33 inpatient and outpatient providers from November 2017 to June 2018. Individual interview participants identified several barriers experienced by parents when transitioning their infant home from the NICU including parental involvement and engagement during NICU stay and during the discharge process. Further exploration within group interviews revealed opportunities to improve discharge communication and processes, standardization of parental education that was lacking due to NICU resource constraints, support for parents' emotional state, and use of technology for infant care in the home. Parents of NICU patients face serious emotional, logistical, and knowledge challenges when transitioning their infant home from the NICU. Understanding and mitigating the challenges of transitioning infants from NICU to home require multistakeholder input from both parents and providers.
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Wreesmann WJW, Lorié ES, van Veenendaal NR, van Kempen AAMW, Ket JCF, Labrie NHM. The functions of adequate communication in the neonatal care unit: A systematic review and meta-synthesis of qualitative research. PATIENT EDUCATION AND COUNSELING 2021; 104:1505-1517. [PMID: 33341329 DOI: 10.1016/j.pec.2020.11.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the main functions of parent-provider communication in the neonatal (intensive) care unit (NICU) and determine what adequate communication entails according to both parents and health professionals. METHODS A systematic review and meta-synthesis of qualitative research. PubMed, Ebsco/PsycINFO, Wiley/Cochrane Library, Ebsco/CINAHL, Clarivate Analytics/Web of Science Core Collection, and Elsevier/Scopus were searched in October-November 2019 for records on interpersonal communication between parents and providers in neonatal care. Title/abstract screening and full-text analysis were conducted by multiple, independent coders. Data from included articles were analyzed using deductive and inductive thematic analysis. RESULTS 43 records were included. Thematic analysis of data resulted in the development of the NICU Communication Framework, including four functions of communication (1. building/maintaining relationships, 2. exchanging information, 3. (sharing) decision-making, 4. enabling parent self-management) and five factors that contribute to adequate communication across these functions (topic, aims, location, route, design) and, thereby, to tailored parent-provider communication. CONCLUSION The NICU Communication Framework fits with the goals of Family Integrated Care to encourage parent participation in infants' care. This framework forms a first step towards the conceptualization of (adequate) communication in NICU settings. PRACTICE IMPLICATIONS Findings can be used to improve NICU communication in practice, in particular through the mnemonic TAILORED.
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Affiliation(s)
| | - Esther S Lorié
- Athena Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Nicole R van Veenendaal
- Department of Pediatrics and Neonatology, OLVG, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, the Netherlands
| | | | | | - Nanon H M Labrie
- Athena Institute, Vrije Universiteit Amsterdam, the Netherlands; Department of Pediatrics and Neonatology, OLVG, Amsterdam, the Netherlands.
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