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Methods Of Healthcare Delivery System01:26

Methods Of Healthcare Delivery System

At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
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Don't Rush It: Conservative Care in Denmark.

Gorm Greisen1, Tine Brink Henriksen2

  • 1Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and gorm.greisen@regionh.dk.

Pediatrics
|September 2, 2018
PubMed
Summary
This summary is machine-generated.

Danish neonatal care evolved from mechanical ventilation to minimally invasive support for preterm infants. Recent initiatives aim to centralize care for extremely preterm infants (<28 weeks gestation) to enhance outcomes and parental support.

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Area of Science:

  • Neonatal Medicine
  • Pediatric Critical Care
  • Public Health Policy

Background:

  • The establishment of the first European neonatal intensive care unit (NICU) in Copenhagen in 1965 marked a significant advancement in preterm infant care.
  • Mechanical ventilation became standard for preterm infants in 1971, but attempts to extend this to extremely immature infants in the early 1980s were unsuccessful.
  • A conservative approach, prioritizing minimally invasive support like nasal continuous positive airway pressure (CPAP) and parental counseling, was adopted and solidified by national consensus.

Purpose of the Study:

  • To describe the evolution of neonatal intensive care policies in Denmark for preterm infants, focusing on the shift towards conservative management and centralization.
  • To highlight the ethical considerations and public opinion influencing treatment decisions for extremely preterm neonates.
  • To outline recent initiatives aimed at further centralizing care for high-risk births to optimize neonatal interventions and parental support.

Main Methods:

  • Historical review of neonatal intensive care unit (NICU) policies and practices in Denmark since 1965.
  • Analysis of national consensus conferences, ethical council opinions, and public opinion surveys regarding preterm infant treatment.
  • Examination of the centralization of care for infants born at <28 weeks' gestation since 2002 and recent proposals for centralizing births >22 weeks' gestation.

Main Results:

  • Denmark transitioned from aggressive mechanical ventilation to a conservative approach using nasal CPAP for preterm infants.
  • National consensus and ethical considerations supported limiting intensive care for extremely preterm infants and prioritizing parental support.
  • Centralization of care for infants <28 weeks' gestation since 2002 has led to uniform policies, with survival at 23 weeks' gestation or less remaining unusual.
  • A recent initiative proposes centralizing all births >22 weeks' gestation to improve parental counseling and neonatal interventions.

Conclusions:

  • Danish neonatal care has evolved towards a conservative, minimally invasive strategy for preterm infants, informed by ethical considerations and public opinion.
  • Centralization of care for the most vulnerable preterm infants has been a key strategy to standardize treatment and improve outcomes.
  • Ongoing professional initiatives aim to further refine care delivery for extremely preterm infants through enhanced centralization, parental support, and neonatal interventions.