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Junaid M Khan MD, Guest Editor
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Back-Transfers of ELBW Infants
Lainwala S, Perritt R, Poole K, et al. Neurodevelopmental and Growth Outcomes of Extremely Low Birth Weight Infants Who Are Transferred From Neonatal Intensive Care Units to Level I or II Nurseries. PEDIATRICS (May 2007); 119: e1079-e1087. Full Text | (PDF)
OBJECTIVE.
Transfer of clinically stable infants to level I and II nurseries
alleviates demands on NICUs and allows better use of beds and
resources. This study compared growth, neurodevelopmental
impairments, postdischarge rehospitalization and deaths, and
compliance for follow-up assessment at 18 to 22 months' corrected age
of extremely low birth weight infants who transferred to level I and
II nurseries with those who continued to receive care to discharge in
a NICU.
METHODS. A retrospective analysis of prospectively collected
data from the National Institute of Child Health and Human Development
Neonatal Research Network was performed. Between January 1998
and June 2002, 4896 infants born with birth weights of 401 to 1000 g
and cared for in 19 National Institute of Child Health and Human
Development Neonatal Research Network centers were included. The
sample consisted of 4392 survivors who received continuing care in
the NICU to discharge home and 504 infants who were transferred to
level I and II nurseries before discharge home. Demographics,
perinatal characteristics, growth, and neurodevelopmental impairments
were compared. Bivariate and logistic regression analyses were
performed.
RESULTS. Transfer of infants to level I and II nurseries was
associated significantly with white race, private insurance,
outborn status, and lower neonatal morbidities and compliance for
follow-up compared with the NICU group. After adjusting for known
covariates, transfer to level I and II nurseries was not associated
with neurodevelopmental impairments or death; however, it was
associated with increased postdischarge rehospitalization.
CONCLUSIONS. Extremely low birth weight infants who are
transferred to level I and II nurseries have similar growth and
neurodevelopmental outcomes to infants who are discharged from a NICU.
They are, however, more likely to be readmitted to the hospital and
are less compliant for follow-up. Establishment of consistent
guidelines for comprehensive discharge planning for level I and II
nurseries may improve follow-up compliance and reduce
rehospitalization rates among these infants who are transferred.
Comments. Discharge planning and guidelines are absolutely important for all levels of nurseries. The outcomes of discharged babies depend primarily on the level of care they receive initially, rather than the level of convalescent care. Not all the babies who are transferred to level 1 and level 2 nurseries have the same outcomes. Also the readmission rate depends on the adequacy of follow up care. If any baby has good follow up, chances of readmission will go down. So it is extremely important to have proper follow up of those babies. JMK.
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