Inter-Neonatal Intensive Care Unit Variation in Discharge Timing: Influence of Apnea and Feeding Management
Premature infants need to attain both medical stability and maturational milestones (specifically, independent thermoregulation, resolution of apnea of prematurity, and the ability to feed by mouth) before safe discharge to home. Current practice also requires premature infants to be observed in hos...
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| Veröffentlicht in: | Pediatrics (Evanston) 2001-10, Vol.108 (4), p.928-933 |
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| creator | Eichenwald, Eric C Blackwell, Mary Lloyd, Janet S Tran, Tai Wilker, Richard E Richardson, Douglas K |
| description | Premature infants need to attain both medical stability and maturational milestones (specifically, independent thermoregulation, resolution of apnea of prematurity, and the ability to feed by mouth) before safe discharge to home. Current practice also requires premature infants to be observed in hospital before discharge for several days (margin of safety) after physiologic maturity is recognized.
To compare postmenstrual age (PMA) at discharge in a homogeneous population of premature infants cared for in different neonatal intensive care units (NICUs) and to assess the impact on hospital stay of the recognition and recording of physiologic maturity and the required margin of safety.
We studied premature infants delivered at 30 to 34 6/7 weeks gestational age (GA), free of significant medical or surgical complications. Medical records of 30 eligible infants consecutively discharged from the hospital before July 1997 from each of 15 NICUs in Massachusetts (9 level 2 and 6 level 3) were reviewed.
A total of 435 infants were included in the study sample. Mean (+/- standard deviation) GA and birth weight of the study population were 33.2 +/- 1.2 weeks and 2024 +/- 389 g, respectively. Infants were discharged at a similar PMA regardless of GA at birth. Considerable variation in the PMA at discharge between hospital sites was observed (range, 35.2 +/- 0.5 weeks to 36.5 +/- 1.2 weeks). Despite the homogeneous study population, hospitals in which infants had the latest PMA at discharge also recorded mature cardiorespiratory and feeding behavior at an older age. Longer duration of pulse oximetry use was associated with later resolution of apnea. Differences in the duration of the margin of safety between sites did not contribute to variation in hospital stay.
NICUs vary widely in length of hospital stay for healthy premature infants. We speculate that this variation results in part from differences in monitoring for and documentation of apnea of prematurity and feeding behavior. |
| doi_str_mv | 10.1542/peds.108.4.928 |
| format | Article |
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To compare postmenstrual age (PMA) at discharge in a homogeneous population of premature infants cared for in different neonatal intensive care units (NICUs) and to assess the impact on hospital stay of the recognition and recording of physiologic maturity and the required margin of safety.
We studied premature infants delivered at 30 to 34 6/7 weeks gestational age (GA), free of significant medical or surgical complications. Medical records of 30 eligible infants consecutively discharged from the hospital before July 1997 from each of 15 NICUs in Massachusetts (9 level 2 and 6 level 3) were reviewed.
A total of 435 infants were included in the study sample. Mean (+/- standard deviation) GA and birth weight of the study population were 33.2 +/- 1.2 weeks and 2024 +/- 389 g, respectively. Infants were discharged at a similar PMA regardless of GA at birth. Considerable variation in the PMA at discharge between hospital sites was observed (range, 35.2 +/- 0.5 weeks to 36.5 +/- 1.2 weeks). Despite the homogeneous study population, hospitals in which infants had the latest PMA at discharge also recorded mature cardiorespiratory and feeding behavior at an older age. Longer duration of pulse oximetry use was associated with later resolution of apnea. Differences in the duration of the margin of safety between sites did not contribute to variation in hospital stay.
NICUs vary widely in length of hospital stay for healthy premature infants. We speculate that this variation results in part from differences in monitoring for and documentation of apnea of prematurity and feeding behavior.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.108.4.928</identifier><identifier>PMID: 11581446</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>Elk Grove Village, IL: Am Acad Pediatrics</publisher><subject>Age Factors ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Apnea - diagnosis ; Apnea - therapy ; Apnea neonatorum ; Babies ; Biological and medical sciences ; Birth Weight ; Body Temperature Regulation - physiology ; Bradycardia - diagnosis ; Bradycardia - therapy ; Care and treatment ; Child Development - physiology ; Diagnosis ; Discharge ; Emergency and intensive care: neonates and children. Prematurity. Sudden death ; Feeding Behavior - physiology ; Gestational Age ; Hospital stays ; Hospital utilization ; Humans ; Infant Food ; Infant Nutritional Physiological Phenomena - physiology ; Infant, Newborn ; Infant, Premature - growth & development ; Infant, Premature, Diseases - diagnosis ; Infant, Premature, Diseases - therapy ; Infants (Premature) ; Intensive care medicine ; Intensive Care Units, Neonatal - statistics & numerical data ; Length of stay ; Length of Stay - statistics & numerical data ; Medical sciences ; Neonatal care ; Patient Discharge - statistics & numerical data ; Pediatrics ; Premature birth ; Premature infants</subject><ispartof>Pediatrics (Evanston), 2001-10, Vol.108 (4), p.928-933</ispartof><rights>2002 INIST-CNRS</rights><rights>COPYRIGHT 2001 American Academy of Pediatrics</rights><rights>COPYRIGHT 2001 American Academy of Pediatrics</rights><rights>Copyright American Academy of Pediatrics Oct 2001</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c532t-af15d8234863de6641e7b55be0f208028d37bb1ea54114ddb9cc47cc5b9ec0d03</citedby><cites>FETCH-LOGICAL-c532t-af15d8234863de6641e7b55be0f208028d37bb1ea54114ddb9cc47cc5b9ec0d03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14124584$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11581446$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eichenwald, Eric C</creatorcontrib><creatorcontrib>Blackwell, Mary</creatorcontrib><creatorcontrib>Lloyd, Janet S</creatorcontrib><creatorcontrib>Tran, Tai</creatorcontrib><creatorcontrib>Wilker, Richard E</creatorcontrib><creatorcontrib>Richardson, Douglas K</creatorcontrib><title>Inter-Neonatal Intensive Care Unit Variation in Discharge Timing: Influence of Apnea and Feeding Management</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>Premature infants need to attain both medical stability and maturational milestones (specifically, independent thermoregulation, resolution of apnea of prematurity, and the ability to feed by mouth) before safe discharge to home. Current practice also requires premature infants to be observed in hospital before discharge for several days (margin of safety) after physiologic maturity is recognized.
To compare postmenstrual age (PMA) at discharge in a homogeneous population of premature infants cared for in different neonatal intensive care units (NICUs) and to assess the impact on hospital stay of the recognition and recording of physiologic maturity and the required margin of safety.
We studied premature infants delivered at 30 to 34 6/7 weeks gestational age (GA), free of significant medical or surgical complications. Medical records of 30 eligible infants consecutively discharged from the hospital before July 1997 from each of 15 NICUs in Massachusetts (9 level 2 and 6 level 3) were reviewed.
A total of 435 infants were included in the study sample. Mean (+/- standard deviation) GA and birth weight of the study population were 33.2 +/- 1.2 weeks and 2024 +/- 389 g, respectively. Infants were discharged at a similar PMA regardless of GA at birth. Considerable variation in the PMA at discharge between hospital sites was observed (range, 35.2 +/- 0.5 weeks to 36.5 +/- 1.2 weeks). Despite the homogeneous study population, hospitals in which infants had the latest PMA at discharge also recorded mature cardiorespiratory and feeding behavior at an older age. Longer duration of pulse oximetry use was associated with later resolution of apnea. Differences in the duration of the margin of safety between sites did not contribute to variation in hospital stay.
NICUs vary widely in length of hospital stay for healthy premature infants. We speculate that this variation results in part from differences in monitoring for and documentation of apnea of prematurity and feeding behavior.</description><subject>Age Factors</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Apnea - diagnosis</subject><subject>Apnea - therapy</subject><subject>Apnea neonatorum</subject><subject>Babies</subject><subject>Biological and medical sciences</subject><subject>Birth Weight</subject><subject>Body Temperature Regulation - physiology</subject><subject>Bradycardia - diagnosis</subject><subject>Bradycardia - therapy</subject><subject>Care and treatment</subject><subject>Child Development - physiology</subject><subject>Diagnosis</subject><subject>Discharge</subject><subject>Emergency and intensive care: neonates and children. Prematurity. Sudden death</subject><subject>Feeding Behavior - physiology</subject><subject>Gestational Age</subject><subject>Hospital stays</subject><subject>Hospital utilization</subject><subject>Humans</subject><subject>Infant Food</subject><subject>Infant Nutritional Physiological Phenomena - physiology</subject><subject>Infant, Newborn</subject><subject>Infant, Premature - growth & development</subject><subject>Infant, Premature, Diseases - diagnosis</subject><subject>Infant, Premature, Diseases - therapy</subject><subject>Infants (Premature)</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units, Neonatal - statistics & numerical data</subject><subject>Length of stay</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Medical sciences</subject><subject>Neonatal care</subject><subject>Patient Discharge - statistics & numerical data</subject><subject>Pediatrics</subject><subject>Premature birth</subject><subject>Premature infants</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpt0s9v0zAUB_AIgVgZXDkiCwnEYSm2YzcOt6qwMamwy8bVerFfUo_EKXbCj_8eV61UhiofYiefl2c9fbPsJaNzJgV_v0Ub54yquZhXXD3KZoxWKhe8lI-zGaUFywWl8ix7FuM9pVTIkj_NzhiTigmxmGXfr_2IIf-Kg4cROrI7-uh-IllBQHLn3Ui-QXAwusET58lHF80GQovk1vXOtx9SSdNN6A2SoSHLrUcg4C25RLTpO_kCHlrs0Y_PsycNdBFfHJ7n2d3lp9vV53x9c3W9Wq5zIws-5tAwaRUvhFoUFhcLwbCspayRNpwqypUtyrpmCFIwJqytK2NEaYysKzTU0uI8e7v_7zYMPyaMo-7TpbHrwOMwRV0yzoqC8QRf_wfvhyn4dDfNuRK7eRUJXexRCx1q55thDGBa9BigGzw2Lr1ellUp-EJWiecneFoWe2dO-XcPfCIj_h5bmGLU6mr9gF6comboOmxRpxmubh7w-Z6bMMQYsNHb4HoIfzSjehcevQtPOigtdApPKnh1GMdU92iP_JCWBN4cAEQDXRPAGxePTjAupBLHzhvXbn65gLtOKULBmfjP9tj5L_EO2to</recordid><startdate>20011001</startdate><enddate>20011001</enddate><creator>Eichenwald, Eric C</creator><creator>Blackwell, Mary</creator><creator>Lloyd, Janet S</creator><creator>Tran, Tai</creator><creator>Wilker, Richard E</creator><creator>Richardson, Douglas K</creator><general>Am Acad Pediatrics</general><general>American Academy of Pediatrics</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20011001</creationdate><title>Inter-Neonatal Intensive Care Unit Variation in Discharge Timing: Influence of Apnea and Feeding Management</title><author>Eichenwald, Eric C ; Blackwell, Mary ; Lloyd, Janet S ; Tran, Tai ; Wilker, Richard E ; Richardson, Douglas K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c532t-af15d8234863de6641e7b55be0f208028d37bb1ea54114ddb9cc47cc5b9ec0d03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Age Factors</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Apnea - diagnosis</topic><topic>Apnea - therapy</topic><topic>Apnea neonatorum</topic><topic>Babies</topic><topic>Biological and medical sciences</topic><topic>Birth Weight</topic><topic>Body Temperature Regulation - physiology</topic><topic>Bradycardia - diagnosis</topic><topic>Bradycardia - therapy</topic><topic>Care and treatment</topic><topic>Child Development - physiology</topic><topic>Diagnosis</topic><topic>Discharge</topic><topic>Emergency and intensive care: neonates and children. Prematurity. Sudden death</topic><topic>Feeding Behavior - physiology</topic><topic>Gestational Age</topic><topic>Hospital stays</topic><topic>Hospital utilization</topic><topic>Humans</topic><topic>Infant Food</topic><topic>Infant Nutritional Physiological Phenomena - physiology</topic><topic>Infant, Newborn</topic><topic>Infant, Premature - growth & development</topic><topic>Infant, Premature, Diseases - diagnosis</topic><topic>Infant, Premature, Diseases - therapy</topic><topic>Infants (Premature)</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units, Neonatal - statistics & numerical data</topic><topic>Length of stay</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Medical sciences</topic><topic>Neonatal care</topic><topic>Patient Discharge - statistics & numerical data</topic><topic>Pediatrics</topic><topic>Premature birth</topic><topic>Premature infants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Eichenwald, Eric C</creatorcontrib><creatorcontrib>Blackwell, Mary</creatorcontrib><creatorcontrib>Lloyd, Janet S</creatorcontrib><creatorcontrib>Tran, Tai</creatorcontrib><creatorcontrib>Wilker, Richard E</creatorcontrib><creatorcontrib>Richardson, Douglas K</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: High School</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eichenwald, Eric C</au><au>Blackwell, Mary</au><au>Lloyd, Janet S</au><au>Tran, Tai</au><au>Wilker, Richard E</au><au>Richardson, Douglas K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inter-Neonatal Intensive Care Unit Variation in Discharge Timing: Influence of Apnea and Feeding Management</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2001-10-01</date><risdate>2001</risdate><volume>108</volume><issue>4</issue><spage>928</spage><epage>933</epage><pages>928-933</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>Premature infants need to attain both medical stability and maturational milestones (specifically, independent thermoregulation, resolution of apnea of prematurity, and the ability to feed by mouth) before safe discharge to home. Current practice also requires premature infants to be observed in hospital before discharge for several days (margin of safety) after physiologic maturity is recognized.
To compare postmenstrual age (PMA) at discharge in a homogeneous population of premature infants cared for in different neonatal intensive care units (NICUs) and to assess the impact on hospital stay of the recognition and recording of physiologic maturity and the required margin of safety.
We studied premature infants delivered at 30 to 34 6/7 weeks gestational age (GA), free of significant medical or surgical complications. Medical records of 30 eligible infants consecutively discharged from the hospital before July 1997 from each of 15 NICUs in Massachusetts (9 level 2 and 6 level 3) were reviewed.
A total of 435 infants were included in the study sample. Mean (+/- standard deviation) GA and birth weight of the study population were 33.2 +/- 1.2 weeks and 2024 +/- 389 g, respectively. Infants were discharged at a similar PMA regardless of GA at birth. Considerable variation in the PMA at discharge between hospital sites was observed (range, 35.2 +/- 0.5 weeks to 36.5 +/- 1.2 weeks). Despite the homogeneous study population, hospitals in which infants had the latest PMA at discharge also recorded mature cardiorespiratory and feeding behavior at an older age. Longer duration of pulse oximetry use was associated with later resolution of apnea. Differences in the duration of the margin of safety between sites did not contribute to variation in hospital stay.
NICUs vary widely in length of hospital stay for healthy premature infants. We speculate that this variation results in part from differences in monitoring for and documentation of apnea of prematurity and feeding behavior.</abstract><cop>Elk Grove Village, IL</cop><pub>Am Acad Pediatrics</pub><pmid>11581446</pmid><doi>10.1542/peds.108.4.928</doi><tpages>6</tpages></addata></record> |
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| identifier | ISSN: 0031-4005 |
| ispartof | Pediatrics (Evanston), 2001-10, Vol.108 (4), p.928-933 |
| issn | 0031-4005 1098-4275 |
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| subjects | Age Factors Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Apnea - diagnosis Apnea - therapy Apnea neonatorum Babies Biological and medical sciences Birth Weight Body Temperature Regulation - physiology Bradycardia - diagnosis Bradycardia - therapy Care and treatment Child Development - physiology Diagnosis Discharge Emergency and intensive care: neonates and children. Prematurity. Sudden death Feeding Behavior - physiology Gestational Age Hospital stays Hospital utilization Humans Infant Food Infant Nutritional Physiological Phenomena - physiology Infant, Newborn Infant, Premature - growth & development Infant, Premature, Diseases - diagnosis Infant, Premature, Diseases - therapy Infants (Premature) Intensive care medicine Intensive Care Units, Neonatal - statistics & numerical data Length of stay Length of Stay - statistics & numerical data Medical sciences Neonatal care Patient Discharge - statistics & numerical data Pediatrics Premature birth Premature infants |
| title | Inter-Neonatal Intensive Care Unit Variation in Discharge Timing: Influence of Apnea and Feeding Management |
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