Transition from NICU to home care complicated by access to medical technology
Health care of discharged neonates is often complicated by the need for uninterrupted access to complex medical technology.
The transition of neonates discharged from a neonatal intensive care unit (NICU) dependent on medical technology may be complicated by the need for continued complex care and increased use of healthcare services, according to research presented at the National Association of Pediatric Nurse Practitioners' 37th National Conference in Atlanta.
Valerie Boebel Toly, PhD, RN, CPNP, assistant professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, and colleagues conducted a retrospective chart review of 71 neonates at a level III NICU and NICU transitional care center in Cleveland. The charts were reviewed at initial discharge, and descriptive analyses were performed; the researchers gathered data on infants' dependence on medical technology such as supplemental oxygen, feeding tubes, tracheostomy, and mechanical ventilation.
The researchers found that post-discharge, the most frequent technologies used were supplemental oxygen and feeding tubes (66% and 46.5% of neonates, respectively). Additionally, 15.5% of neonates used mechanical ventilation, 21.1% used a gastronomy tube, and 25.4% used a nasogastric tube. Mean total hospital stay length for technology-dependant neonates was 108.6 days, compared with 25.7 days for nontechnology-dependent neonates, and the mean number of ER visits and rehospitalizations 1 year post-discharge was 1.8 and 3, respectively.
“Technology-dependent neonates require vigilant, complex care and treatment by their parents following discharge,” concluded Dr Toly and colleagues. “The period of transition … is a particularly vulnerable period for neonates and their parents.”
“Healthcare providers can provide needed assessment and support for technology-dependent neonates and their parents during the vulnerable transition period upon initial discharge from the hospital to home.”
Editor's note: The original version of this article included an error in the percentage of neonates who used mechanical ventilation post-discharge; the correct number is 15.5%. The article was corrected on April 1, 2016, to reflect this.
- Toly VB, Musil CM, Bieda A. Neonates discharged home dependent on medical technology: Characteristics and outcomes. Poster presented at: National Association of Pediatric Nurse Practitioners 37th National Conference on Pediatric Health Care; March 16-19, 2016; Atlanta, GA; Accessed March 18, 2016.