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Extremely long hospitalizations of newborns in the United States: data, descriptions, dilemmas
1Department of Nursing, Sonoma State University, Rohnert Park, CA, USA. acatlin@napanet.net
Insights
This study identifies 680 infants hospitalized for over six months, highlighting extreme prematurity and necrotizing enterocolitis as key factors. Healthcare providers described challenges in caring for these neonates, sometimes due to prolonged, futile treatments.
Area of Science:
- Neonatal Medicine
- Pediatric Healthcare
- Medical Informatics
Background:
- Neonatal and pediatric healthcare professionals care for technologically dependent newborns with prolonged hospital stays, often exceeding six months.
- Limited research exists on identifying these critically ill infants and understanding staff/parental responses to extended hospitalizations.
Purpose of the Study:
- To provide numerical data and descriptive insights into acutely and chronically ill newborns experiencing hospitalizations longer than 179 days in the U.S.
- To identify pathologies associated with extended newborn hospital stays.
Main Methods:
- Utilized method triangulation, including the national Healthcare Cost and Utilization Project (HCUPKID) 2003 dataset, a custom LONGTERM survey, and qualitative questions.
- Collected anecdotal reports from neonatal nurses and physicians caring for infants with hospital stays exceeding six months.
Main Results:
- Identified 680 infants with hospital stays of six months or longer in 2003 using HCUP data.
- Received 422 survey responses and 228 firsthand accounts from providers regarding care for these infants.
- Extreme prematurity, respiratory distress, and necrotizing enterocolitis were primary contributors to prolonged stays.
- Providers perceived that futile treatments were sometimes insisted upon, prolonging hospitalizations.
Conclusions:
- Prolonged neonatal hospitalizations are a significant issue, often linked to severe medical conditions and complex care decisions.
- Further research is needed to explore the ethical and practical implications of extended neonatal intensive care and support for families.
Problem:
Neonatal and pediatric nurses and physicians care for newborn children who have been saved by technological support but who then spend extremely long periods of time in the hospital, perhaps never being able to be discharged to home. There has been little research identifying newborns who are too sick to be discharged from the health care setting and rare reports of staff or parental response to these long-term hospitalizations.
Purpose:
This study provides both the numerical data and description of acutely, chronically ill newborn children whose illnesses caused hospitalizations for greater than 6-months (179 days) in the US.
Methodology:
Method triangulation using a national data set (HCUPKID 2003), a researcher created LONGTERM survey, and a qualitative question was used to identify pathologies associated with newborn length of stays greater than 6 months. Neonatal nurses and physicians provided descriptions of children spending at least 6 months in the hospital, including anecdotal reports of caring for those children.
Results:
The national H-CUP data set identified 680 infants staying 6 months or longer in the hospital during 2003. Four hundred and twenty-two providers submitted LONGTERM surveys describing these infants, with 228 first hand reports on how it felt to care for children with hospital stays between 6 months and 6 years. Extreme prematurity, respiratory distress and necrotizing enterocolitis contributed to the extremely long hospital stays. Nurse and physician participants felt that extremely long hospital stays were often due to situations in which parents or colleagues were insisting upon continued futile treatment.
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