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Same baby, different care: variations in practice between neonatologists and pediatric intensivists
Liron Borenstein-Levin1,2, Ori Hochwald3,4, Josef Ben-Ari4,5
1Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. liron.boren@gmail.com.
European Journal of Pediatrics
|January 10, 2022
Summary
Neonatal intensive care (NICU) and pediatric intensive care (PICU) physicians show significant differences in managing critical neonatal cases. Developing joint guidelines can optimize care for vulnerable infants in both NICU and PICU settings.
Area of Science:
- Neonatal and Pediatric Critical Care Medicine
- Clinical Practice Variation
- Evidence-Based Medicine
Background:
- Variability in neonatal care between neonatal intensive care units (NICU) and pediatric intensive care units (PICU) is documented.
- Lack of evidence-based literature and differing practice traditions contribute to care disparities.
Purpose of the Study:
- To identify and explore significant differences in clinical care practices between NICU and PICU physicians in Israel.
- To compare treatment choices for common neonatal critical care scenarios.
Main Methods:
- A scenario-based electronic survey was distributed to all NICU and PICU physicians in Israel.
- 110 physicians completed the survey, detailing treatment preferences for severe pneumonia, post-cardiac surgery, and congenital diaphragmatic hernia (CDH).
Main Results:
- Significant differences observed in respiratory support, sedation/analgesia, and vascular access strategies.
- NICU physicians favored non-cuffed endotracheal tubes and umbilical lines, while PICU physicians opted for different approaches.
- Discrepancies noted in hemodynamic management and medication choices for CDH.
Conclusions:
- Major differences exist in respiratory, hemodynamic, sedation, and vascular access care between NICU and PICU physicians.
- Field-specific guidelines and traditions contribute to these variations.
- Joint committees are recommended to establish optimal, evidence-based treatments for critically ill neonates.
Keywords:
Critical careInfantIntensive care unitsNeonatal intensive care unitsNeonatesPediatricPrematureSurveys and questionnairesMore Related Videos
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