Discharge of Medically Complex Infants and Developmental Follow-up.

Published on Jun 1, 2021in Pediatrics in Review
· DOI :10.1542/PIR.2020-000638
Jillian Connors (Boston Children's Hospital), Jillian Connors (Boston Children's Hospital)+ 0 AuthorsDeborah Campbell3
Estimated H-index: 3
(Boston Children's Hospital)
Source
Abstract
At the time of discharge from the NICU, many infants have ongoing complex medical issues that will require coordinated, multispecialty follow-up. Discharge planning and transfer of care for infants with medical complexity require a multidisciplinary team effort that begins early during the NICU hospitalization. It is critical that the primary care physician is involved in this process because he or she will serve as the chief communicator and coordinator of care after discharge. Although some infants with medical complexity may be followed in specialized multidisciplinary NICU follow-up clinics, these are not universally available. The responsibility then falls to the primary care physician to coordinate with different subspecialties based on the infant's needs. Many infants with medical complexity are technology-dependent at the time of discharge and may require home oxygen, ventilators, monitors, or tube feeding. Prematurity, critical illness, and prolonged NICU hospitalization that lead to medical complexity also increase the risk of neurodevelopmental delay or impairment. As such, these infants will not only require routine developmental surveillance and screening by the primary care physician but also should be followed longitudinally by a neurodevelopmental specialist, either a developmental-behavioral pediatrician or a neonatologist with experience in neurodevelopmental assessment.
References0
Newest
#1Katie FeehanH-Index: 1
#2Folasade KehindeH-Index: 1
Last. Renee M. Turchi (Drexel University)H-Index: 15
view all 8 authors...
Objective Typical primary care practices are often not equipped to meet the medical, developmental or social needs of infants discharged from a neonatal intensive care unit (NICU). These needs are exacerbated for infants and caregivers residing in poverty. This article discusses a multidisciplinary, family-centered medical home designed to address the needs of this special population.
1 CitationsSource
#1Paul H. Lipkin (Johns Hopkins University)H-Index: 18
#2Michelle M. Macias (MUSC: Medical University of South Carolina)H-Index: 20
Early identification and intervention for developmental disorders are critical to the well-being of children and are the responsibility of pediatric professionals as an integral function of the medical home. This report models a universal system of developmental surveillance and screening for the early identification of conditions that affect children’s early and long-term development and achievement, followed by ongoing care. These conditions include autism, deafness/hard-of-hearing, intellectu...
40 CitationsSource
#1Kei Lui (UNSW: University of New South Wales)H-Index: 48
#2Shoo K. Lee (U of T: University of Toronto)H-Index: 63
Last. Prakesh S. Shah (U of T: University of Toronto)H-Index: 67
view all 16 authors...
Objective To evaluate outcome trends of neonates born very preterm in 11 high-income countries participating in the International Network for Evaluating Outcomes of neonates. Study design In a retrospective cohort study, we included 154 233 neonates admitted to 529 neonatal units between January 1, 2007, and December 31, 2015, at 240/7 to 316/7 weeks of gestational age and birth weight Results For composite outcome including BPD, the trend decreased in Canada and Israel but increased in Australi...
36 CitationsSource
#1Raymond C. StetsonH-Index: 2
#2Jennifer L. FangH-Index: 7
Last. Robert M. Jacobson (Mayo Clinic)H-Index: 69
view all 4 authors...
BACKGROUND AND OBJECTIVES: Infants in NICUs are at risk for underimmunization. Adherence to the routine immunization schedule recommended by the Advisory Committee for Immunization Practices minimizes the risk of contracting vaccine-preventable illnesses in this vulnerable population. From January 2015 to June 2017, only 56% (419 of 754) of the infants in our Mayo Clinic level IV NICU were fully up to date for recommended immunizations at the time of discharge or hospital unit transfer. We aimed...
2 CitationsSource
#1Susan Hill (Great Ormond Street Hospital for Children NHS Foundation Trust)H-Index: 21
Abstract The child born today with chronic intestinal failure (IF) can expect to survive throughout childhood and into adult life even if dependent on parenteral nutrition (PN) support. The three major aetiologies of chronic IF are short bowel syndrome (SBS), intestinal dysmotility and mucosal disease. SBS is the commonest of these conditions in infancy, most frequently subsequent to resection for necrotising enterocolits (NEC). The focus of IF management is to ensure appropriate weight gain and...
2 CitationsSource
#1Mark L. Wolraich (OU: University of Oklahoma)H-Index: 26
#2Joseph F. Hagan (UVM: University of Vermont)H-Index: 10
Last. Hyperactive DisorderH-Index: 1
view all 19 authors...
Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and can profoundly affect the academic achievement, well-being, and social interactions of children; the American Academy of Pediatrics first published clinical recommendations for the diagnosis and evaluation of ADHD in children in 2000; recommendations for treatment followed in 2001.
1,218 CitationsSource
#1Michael L. O'Byrne (UPenn: University of Pennsylvania)H-Index: 18
#2Marisa E. Millenson (Children's Hospital of Philadelphia)H-Index: 4
Last. Andrew C. Glatz (UPenn: University of Pennsylvania)H-Index: 30
view all 11 authors...
Abstract Background The risks and benefits of pharmacologic treatment and operative closure of patent ductus arteriosus (O-PDA) in premature infants remain controversial. Recent series have demonstrated the feasibility of transcatheter PDA closure (TC-PDA) in increasingly small infants. The effect of this change on practice has not been evaluated. Methods A multicenter observational study of infants treated in neonatal intensive care units in hospitals contributing data to the Pediatric Health I...
5 CitationsSource
#1Sadie L. Williams (UC: University of Cincinnati)H-Index: 1
#2Natalie M. Popowics (Duke University)H-Index: 1
Last. Stephanie L. Merhar (UC: University of Cincinnati)H-Index: 18
view all 5 authors...
NICU patients are commonly discharged home with nasogastric (NG) or gastrostomy (G-tube) feeding, but wide practice variation exists. The objective of this study was to evaluate feeding and growth outcomes and complications in NICU patients discharged home with NG or G-tube feeding. Retrospective cohort study of infants discharged from a Level IV NICU with an NG or G-tube who had follow up to 1 year. Clinical characteristics and outcomes were compared between groups. The study sample included 26...
4 CitationsSource
#1Payal Trivedi (Boston Children's Hospital)H-Index: 1
#2Kristen Glass (Boston Children's Hospital)H-Index: 7
Last. Akif Ündar (Boston Children's Hospital)H-Index: 41
view all 9 authors...
: The objective of this study was to describe a single-center experience with neonatal and pediatric extracorporeal life support (ECLS) and compare patient-related outcomes with those of the Extracorporeal Life Support Organization (ELSO) Registry. A retrospective review of subject characteristics, outcomes, and complications of patients who received the ECLS at Penn State Health Children's Hospital (PSHCH) from 2000 to 2016 was performed. Fisher's exact test was used to compare the PSHCH outcom...
5 CitationsSource
#1Joyce A MartinH-Index: 67
#2Hamilton BeH-Index: 1
Last. Michelle J K OstermanH-Index: 30
view all 3 authors...
This report presents selected highlights from 2018 final birth data on key demographic, health care utilization, and infant health indicators. General fertility rates (the number of births per 1,000 women aged 15-44) and teen birth rates are presented. Also shown are the distribution of births with a previous cesarean delivery (vaginal births after previous cesarean [VBAC] and repeat cesarean delivery) and the distribution of births by gestational age. All indicators are compared between 2017 an...
38 Citations
Cited By0
Newest