Early discharge and hospital-assisted home care is associated with better neurodevelopmental outcome in preterm infants

Dimensions and components of hospital-at-home care: a systematic review

BACKGROUND AND AIM

Hospital-at-home (HaH) care is known as a healthcare delivery approach providing acute care services at home as an alternative to traditional hospital care. This study aimed to explore the dimensions and components of HaH care.

METHODS

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The databases including ScienceDirect, Scopus, PubMed, the Cochrane library, the Web of Science Core Collection, and the Wiley online library were searched for articles on HaH care dimensions and components of from early 2000 to February 19, 2024. The inclusion criteria of the study included articles published in the English language, and and those pertaining to various dimensions and components of HaH care. The quality of the studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and data were analysed using the framework analysis method.

RESULTS

A total of 4078 articles were retrieved. After screening and quality assessment, 179 articles were included in the review, identifying 88 dimensions and components of HaH care across seven main categories: benefits, challenges and obstacles, facilitators, management-related factors, medical conditions, factors associated with patients and their families, and factors associated with caregivers. The common components included cost savings (n = 30), patient and family satisfaction (n = 23), reduction in re-admissions (n = 13), medication management (n = 12), communication, coordination, and cooperation among healthcare teams, patients, and families (n = 12), preferences of patients and families (n = 12), and education of patients, families, and healthcare teams (n = 10).

CONCLUSION

Based on the results, HaH includes many and diverse dimensions and components. So, healthcare policymakers and planners are urged to consider the dimensions and components of HaH care including benefits, challenges and obstacles, facilitators, management-related factors, medical conditions, factors associated with patients and their families, and factors associated with caregivers when developing models and programs to ensure effective outcomes following implementation.

Changes in In-Hospital Survival and Long-Term Neurodevelopmental Outcomes of Extremely Preterm Infants: A Retrospective Study of a Japanese Tertiary Center

OBJECTIVES

The objective of this study was to elucidate whether the survival and long-term neurodevelopmental outcomes of extremely preterm infants have improved in a Japanese tertiary center with an active treatment policy for infants born at 22-23 weeks of gestation.

STUDY DESIGN

This single-centered retrospective cohort study enrolled extremely preterm infants treated at Saitama Medical Center, Saitama Medical University, from 2003 to 2014. Patients with major congenital abnormalities were excluded. Primary outcomes were in-hospital survival and severe neurodevelopmental impairment (NDI) at 6 years of age, which was defined as having severe cerebral palsy, severe cognitive impairment, severe visual impairment, or deafness. We assessed the changes in primary outcomes between the first (period 1; 2003-2008) and the second half (period 2; 2009-2014) of the study period and evaluated the association between birth-year and primary outcomes using multivariate logistic regression models.

RESULTS

Of the 403 eligible patients, 340 (84%) survived to discharge. Among 248 patients available at 6 years of age, 43 (14%) were classified as having severe NDI. Between the 2 periods, in-hospital survival improved from 155 of 198 (78%) to 185 of 205 (90%), but severe NDI increased from 11 of 108 (10%) to 32 of 140 (23%). In multivariate logistic regression models adjusted for gestational age, birthweight, sex, singleton birth, and antenatal corticosteroids, the aOR (95% CI) of birth-year for in-hospital survival and severe NDI was 1.2 (1.1-1.3) and 1.1 (1.0-1.3), respectively.

CONCLUSION

Mortality among extremely preterm infants has improved over the past 12 years; nevertheless, no significant improvement was observed in the long-term neurodevelopmental outcomes.

Multiprofessional cross-site working between a level 1 and a level 3 neonatal unit: a retrospective cohort study

OBJECTIVE

To assess the association of short-term neonatal outcomes with cross-site working of multiple healthcare professional teams between a level 3 and a level 1 neonatal unit.

DESIGN

Retrospective cohort study.

SETTING

A level 1 neonatal unit in London.

PATIENTS

All infants admitted to the neonatal unit, between 2010 and 2021.

INTERVENTIONS

The clinical service was rearranged in 2014 with the introduction of cross-site working between the level 1 unit and a level 3 unit of neonatal doctors, nurses and allied healthcare professionals.

MAIN OUTCOME MEASURES

Admission of infants with a temperature less than 36°C, length of stay and time to first consultation by a senior team member.

RESULTS

A total of 4418 infants were admitted during the study period. The percentage of infants delivered at a gestation below 32 weeks was higher in the pre-cross-site period (8.9%) compared with the cross site period (3.6%, p<0.001). The percentage of infants with an Apgar score less than 8 at 10 min was higher in the pre-cross-site period (6.2%) compared with the cross-site period (3.4%, p=0.001). More infants were admitted with a temperature less than 36°C in the pre-cross site period (12.3%) compared with the cross site period (3.7%, p<0.001). The median (IQR) duration of time to first consultation by a senior team member was higher in the pre-cross-site period (1 (0.5-2.6) hours) compared with the cross-site period (0.5 (0.2-1.3) hours) (p<0.001). The median (IQR) length of stay was 4 (2-11) days in the pre-cross-site period and decreased to 2 (1-4) days in the cross-site period (p<0.001).

CONCLUSIONS

Cross-site working was associated with lower rates of admission hypothermia, shorter duration of stay and earlier first senior consultation.