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Neonates and Infants Discharged Home Dependent on Medical Technology: Characteristics and Outcomes
Valerie Boebel Toly1, Carol M Musil, Amy Bieda
1Frances Payne Bolton School of Nursing (Drs Toly, Musil, Bieda, and Dowling), and Department of Epidemiology and Biostatistics, School of Medicine (Dr Sattar), Case Western Reserve University, Cleveland, Ohio; and Neonatal Transitional Care Center, Rainbow Babies & Children's Hospital, Cleveland, Ohio (Ms Barnett).
Insights
Technology-dependent neonates require specialized care at home. Female infants, those with gastrostomy tubes, and longer hospital stays increase rehospitalization risk for these vulnerable infants.
Area of Science:
- Neonatal intensive care
- Pediatric technology dependence
- Healthcare transition
Background:
- Neonates in NICU often require medical technology for survival post-discharge.
- Technology use necessitates specialized parental education on neonatal assessment and device operation.
- Transitioning home with technology-dependent infants is challenging and linked to increased healthcare utilization.
Purpose of the Study:
- To determine the incidence and characteristics of technology-dependent neonates.
- To analyze healthcare utilization outcomes (ER visits, rehospitalizations) post-discharge.
- To identify factors associated with healthcare utilization in this population.
Main Methods:
- Retrospective medical record review of 71 technology-dependent neonates.
- Analysis of demographic characteristics, hospital length of stay, and technology type.
- Regression analysis of 22 neonates with 1-year postdischarge data to assess healthcare utilization.
Main Results:
- 40% of neonates were born between 23-26 weeks gestation with <1000g birth weight.
- Supplemental oxygen (66%) and feeding tubes (46.5%) were most common technologies.
- Female sex, gastrostomy tubes, and longer initial hospital stay increased rehospitalization risk.
Conclusions:
- Family assessment and support, especially for mothers, are crucial post-discharge.
- Longitudinal research is needed to understand long-term outcomes for technology-dependent infants.
Background:
Preterm neonates and neonates with complex conditions admitted to a neonatal intensive care unit (NICU) may require medical technology (eg, supplemental oxygen, feeding tubes) for their continued survival at hospital discharge. Medical technology introduces another layer of complexity for parents, including specialized education about neonatal assessment and operation of technology. The transition home presents a challenge for parents and has been linked with greater healthcare utilization.
Purpose:
To determine incidence, characteristics, and healthcare utilization outcomes (emergency room visits, rehospitalizations) of technology-dependent neonates and infants following initial discharge from the hospital.
Methods:
This descriptive, correlational study used retrospective medical record review to examine technology-dependent neonates (N = 71) upon discharge home. Study variables included demographic characteristics, hospital length of stay, and type of medical technology used. Analysis of neonates (n = 22) with 1-year postdischarge data was conducted to identify relationships with healthcare utilization. Descriptive and regression analyses were performed.
Findings:
Approximately 40% of the technology-dependent neonates were between 23 and 26 weeks' gestation, with birth weight of less than 1000 g. Technologies used most frequently were supplemental oxygen (66%) and feeding tubes (46.5%). The mean total hospital length of stay for technology-dependent versus nontechnology-dependent neonates was 108.6 and 25.7 days, respectively. Technology-dependent neonates who were female, with a gastrostomy tube, or with longer initial hospital length of stay were at greater risk for rehospitalization.
Implications For Practice:
Assessment and support of families, particularly mothers of technology-dependent neonates following initial hospital discharge, are vital.
Implications For Research:
Longitudinal studies to determine factors affecting long-term outcomes of technology-dependent infants are needed.
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