Perspectives and attitudes of pediatricians concerning post-discharge care practice of premature infants

The Use of Telehealth to Improve Handoffs Between Neonatologists and Primary Care Providers for Medically Complex Infants

As part of the Supporting Pediatric Research Outcomes Utilizing Telehealth (SPROUT) collaboration, three institutions (University of California, Davis, Children's Hospital Colorado, and Children's Hospital of Philadelphia) sought to improve communication with primary care providers (PCPs) using telehealth. This project connected families of neonatal intensive care unit (NICU) patients, their PCPs, and their NICU team through telehealth to provide an enhanced hospital handoff. This case series reports four cases that exemplify the benefits of these enhanced hospital handoffs: Case 1: assisting with changing care plans after NICU discharge, Case 2: demonstrating physical findings, Case 3: incorporation of additional subspecialties through telehealth, Case 4: arranging care for remote patients. Although these cases demonstrate some of the potential benefits of these handoffs, further study is needed to determine acceptability of these handoffs and to see whether they impact patient outcomes.

Development of a post discharge telecare program for premature infants in Covid 19 era: Protocol for a mixed methods study

BACKGROUND

Post-discharge care of premature infants is an important goal that can provide a safe transition for these infants from the hospital to the home setting, especially who has undergone significant changes during Covid19. Most premature infants experience complications because of routine hospital care termination after discharge because of limitations and barriers that Covid can create for the infant and the parents. It is necessary to develop a program that provides ongoing care for these infants. Telecare is one feasible option that can be used to implement this program. The study aims to develop a post-discharge telecare program for premature infants in the Covid era in Iran.

MATERIAL AND METHODS

This is an exploratory mixed-methods study that will be conducted by Qualitative-quantitative methods in three consecutive phases at Isfahan University of Medical Sciences in January 2022. In the first phase, a qualitative study will be conducted to identify and determine the needs and strategies in the Covid 19 era to promote premature infant care after discharge. The data will be collected through deep semi-structured interviews. Participants (parents, physicians, and nurses) will be selected by purposive sampling methods, and the conventional content analysis method will be used for data analysis. In the second phase, the identified infants' and parents' needs as an initial draft of the program will be prioritized and confirmed by the modified Delphi method and a panel of experts. The final program will be developed in this phase. In the quantitative third phase, the confirmed program will be implemented as a semi-experimental study that uses a telecare strategy. Finally, we will evaluate the effectiveness of this telecare program.

RESULT

A program that uses qualitative and quantitative methods can provide evidence for promoting premature infant health after hospital discharge in Covid 19 era.

CONCLUSION

We anticipate that this program will promote knowledge and empower health team members, especially nurses, to provide ongoing telecare for premature infants.

After NICU discharge: Feeding and growth of low-income urban preterm infants through the first year

BACKGROUND

Little is known about preterm infant feeding and growth in the outpatient setting, and there are no standardized post-hospital discharge feeding guidelines. This study aims to describe post-neonatal intensive care unit (NICU) discharge growth trajectories of very preterm (<32 weeks gestational age (GA)) and moderately preterm (32-34 0/7 weeks GA) infants managed by community providers and to determine the association between post-discharge feeding type and growth Z-scores and z-score changes through 12 months corrected age (CA).

METHODS

This retrospective cohort study included very preterm infants (n = 104) and moderately preterm infants (n = 109) born 2010-2014 and followed in community clinics for low-income, urban families. Infant home feeding and anthropometry were abstracted from medical records. Repeated measures analysis of variance calculated adjusted growth z-scores and z-score differences between 4 and 12 months CA. Linear regression models estimated associations between 4 months CA feeding type and 12 months CA anthropometry.

RESULTS

Moderately preterm infants on nutrient-enriched vs. standard term feeds at 4 months CA had significantly lower length z-scores at NICU discharge that persisted to 12 months CA (-0.04 (0.13) vs. 0.37 (0.21), respectively, P = .03), with comparable length z-score increase for both groups between 4 and 12 months CA. Very preterm infants' 4 months CA feeding type predicted 12 month CA body mass index z-scores (β=-0.66 (-1.28, -0.04)).

CONCLUSION

Community providers may manage preterm infant post-NICU discharge feeding in the context of growth. Further research is needed to explore modifiable drivers of infant feeding and socio-environmental factors that influence preterm infant growth trajectories.

Risk factors for hospital readmission among infants with prolonged neonatal intensive care stays

OBJECTIVE

To assess risk factors associated with 30-day hospital readmission after a prolonged neonatal intensive care stay.

STUDY DESIGN

Retrospective analysis of 57,035 infants discharged >14 days from the NICU between 2013 and 2016. Primary outcome was 30-day, all-cause hospital readmission. Adjusted likelihood of readmission accounting for demographic and clinical characteristics, including chronic conditions was also estimated.

RESULTS

The 30-day readmission rate was 10.7%. Respiratory problems accounted for most (31.0%) readmissions. In multivariable analysis, shunted hydrocephalus [OR 2.2 (95%CI 1.8-2.7)], gastrostomy tube [OR 2.0 (95%CI 1.8-2.3)], tracheostomy [OR 1.5 (95%CI 1.2-1.8)], and use of public insurance [OR 1.3 (95%CI 1.2-1.4)] had the highest likelihood of readmission. Adjusted hospital readmission rates varied significantly (p < 0.001) across hospitals.

CONCLUSIONS

The likelihood of hospital readmission was highest for infants with indwelling medical devices and public insurance. These findings will inform future initiatives to reduce readmission for high risk infants with medical and social complexity.

Socio-family support for parents of technology-dependent extremely preterm infants after hospital discharge

Parents of extremely preterm infants (<28 weeks of gestation) report high levels of stress and anxiety related to daily needs after hospital discharge. Social support has a significant role in reducing the negative psychological impact of preterm birth and parents' adaptation to caregiving. We conducted a hermeneutic phenomenological study using Gadamer's approach to explore and describe the experiences of parents of technology-dependent extremely preterm infants of socio-family support after hospital discharge. The study was conducted in four several Spanish organizations for families with preterm infants. It includes 17 semi-structured interviews (12 mothers and 5 fathers). Three main themes emerged from the analysis: post-discharge formal support for extremely preterm infants and families, home neonatal care: family support, and a thread of hope: parent-to-parent support. The parents' main support resources to deal with everyday difficulties are healthcare professionals, their partners, grandmothers, and peer parents of extremely preterm infants. The findings may be used to guide healthcare professionals in the creation of a support program according to preferences and needs of parents.

Transitional care experiences of caregivers of preterm infants hospitalized in a neonatal intensive care unit: A qualitative descriptive study

Aim

To describe the transitional care experiences and nursing needs of caregivers of preterm infants hospitalized in neonatal intensive care units (NICUs).

Design

A qualitative descriptive study.

Methods

We conducted semi‐structured interviews with the 24 caregivers of preterm infants admitted to Children's Hospital, Soochow University. All data were collected by a trained and experienced interviewer. The caregivers' experiences were described using qualitative content analysis.

Results

Six Five themes emerged from the analysis: (a) uncertainty about the disease; (b) anxiety due to restricted visitation; (c) exhaustion from overwork; (d) emotional depression; (e) low care ability; (f) a variety of channels for help and a positive response. This study provides a basis for understanding the needs of their caregivers so that effective coping strategies can be implemented. Nurses' education and practice should focus on understanding the real experiences of the parents of preterm infants during transitional nursing.

Factors related to enrolment in early therapy services following neonatal intensive care unit discharge

AIM

Early therapy can improve developmental outcomes for preterm infants. However, preterm infants who are referred have low enrolment in early therapy services following neonatal intensive care unit (NICU) discharge. This manuscript aims to investigate the relationship between infant medical and sociodemographic factors and enrolment in early therapy services post-NICU discharge, when system-related barriers to access are minimised.

METHODS

This was a retrospective investigation of 89 families with infants born ≤32 weeks of gestation. Families were approached for enrolment into early therapy services following NICU discharge through Baby Bridge programming, which aims to improve access to therapy services following NICU discharge.

RESULTS

Seventy-three (82%) families enrolled in early therapy services, and 16 (18%) families declined. Parents were more likely to enrol in early therapy if they had public insurance (P = 0.01), a maternal psychiatric diagnosis (P = 0.02) or additional children under 18 years in the home (P = 0.01). No infant medical factors were related to enrolment.

CONCLUSION

Although enrolment rates were high, 18% of families refused therapy services, despite removing system-related barriers to access. Targeted interventions can be developed to increase enrolment in early therapy services among populations who are most likely to refuse therapy services after NICU discharge.

Using telehealth to support pediatricians in newborn care

This clinical scenario-based review will discuss how telehealth programs improve access to specialty care for neonates, their caregivers, and primary care pediatricians. Tele-resuscitation supports pediatricians during complex, high-risk newborn resuscitations, improves the quality of delivery room care, and reduces odds of transfer to a higher level of care. Neonatologists and other pediatric specialists use telehealth to provide more effective consultations that positively influence management decisions and patient outcomes. When neonatologists provide video visits to home and meet virtually with primary care pediatricians, infants discharged from the NICU experience fewer emergency room visits and hospital re-admissions. With further implementation and dissemination of neonatal telemedicine programs, it is important that these programs continue to be thoughtfully designed to achieve measurable value that is relevant to patients and caregivers, providers, healthcare systems, and payers.

Telemedicine, a tool for follow-up of infants discharged from the NICU? Experience from a pilot project

OBJECTIVE

Follow-up of infants from the NICU by neonatologist is limited to premature and complicated infants although parents of infants with advanced gestation may have concerns as well. We compared parental questions of infants < 35 weeks gestation (group A), during virtual telemedicine visits, to ≥35 week infants (group B).

STUDY DESIGN

In a retrospective cohort study, questions asked by parents were extracted from the electronic medical record of all infants post discharge from the NICU, after their pediatrician visit.

RESULTS

Gestation and birth weight of infants in group A were significantly lower than group B but their stay was longer. There were no significant differences in the number of parents who had questions, between the groups (A 68.1% vs B 67.3%, p = 0.91, 95% CI 0.46-1.99, OR = 0.96).

CONCLUSIONS

Telemedicine is a feasible tool for follow-up of NICU infants post discharge. Parents of infants with advanced gestation and weight may benefit from NICU follow-up.

The Baby Bridge program: A sustainable program that can improve therapy service delivery for preterm infants following NICU discharge

Objective

The aim of this project was to determine revenues and costs over time to assess the sustainability of the Baby Bridge program.

Methods

The Baby Bridge program was developed to promote timely, consistent and high quality early therapy services for high-risk infants following neonatal intensive care unit (NICU) discharge. Key features of the Baby Bridge program were defined as: 1) having the therapist establish rapport with the family while in the NICU, 2) scheduling the first home visit within one week of discharge and continuing weekly visits until other services commence, 3) conducting comprehensive assessments to inform targeted interventions by a skilled, single provider, and 4) using a comprehensive therapeutic approach while collaborating with the NICU medical team and community therapy providers. The Baby Bridge program was implemented with infants hospitalized in an urban Level IV NICU from January 2016 to January 2018. The number of infants enrolled increased gradually over the first several months to reach the case-load capacity associated with one full-time therapist by mid-2017. Costs of the therapists delivering Baby Bridge services, travel, and equipment were tracked and compared with claim records of participants. The operational cost of Baby Bridge programming at capacity was estimated based on the completed and anticipated claims and reimbursement of therapy services as a means to inform possible scale-ups of the program.

Results

In 2016, the first year of programming, the Baby Bridge program experienced a loss of $26,460, with revenue to the program totaling $11,138 and expenses totaling $37,598. In 2017, the Baby Bridge program experienced a net positive income of $2,969, with revenues to the program totaling $53,989 and expenses totaling $51,020. By Spring 2017, 16 months after initiating Baby Bridge programming, program revenue began to exceed cost. It is projected that cumulative revenue would have exceeded cumulative costs by January 2019, 3 years following implementation. Net annual program income, once scaled up to capacity, would be approximately $16,308.

Discussion

There were initial losses during phase-in of Baby Bridge programming associated with operating far below capacity, yet the program achieved sustainability within 16 months of implementation. These costs related to implementation do not consider the potential cost reduction due to mitigated health burden for the community and families, particularly due to earlier receipt of therapy services, which is an important area for further inquiry.