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Neonatal intensive care unit discharge of infants with cardiorespiratory events: Tri-country comparison of academic centers
This article includes multiple AASPP members as authors. It was published in the Journal of Neonatal-Perinatal Medicine in January of 2016:
Neonatal intensive care unit (NICU) and special nursery admissions occur in 7–14% of all births. The gestational age of infants admitted spans from 23 weeks to post term gestation of greater than 42 weeks. The average length of stay for an infant in the NICU ranges from a few days to several months.
The discharge of infants from the NICU is a complex process that requires forethought and planning. This can be the direct result of the patients themselves, coordination of care after a prolonged hospital stay, and resolution and/or improvement of complex multifactorial medical diagnoses. The risk assessment for hospital readmission and death within the first year following discharge remains a concern.
Taking this into account, additional factors to be considered are a family’s readiness for discharge and completion of necessary education and training. Families often need additional supports such as home equipment and technological support. Appropriate multidisciplinary follow-up should also be arranged prior to discharge.
The true cornerstone of the discharge decision is the readiness of the infant. The neonatal period is characterized by physiologic changes greatly influenced by gestational age and confounding illnesses and complications. Respiratory difficulties remain one of the greatest challenges, apnea being a common problem. The widely accepted definition of apnea in infants is a cessation of breathing for greater than or equal to 20 seconds, or a shorter respiratory pause associated with oxygen desaturation and or bradycardia. While the broad general consensus of NICU discharge is based on medical stability and physiologic readiness of infants, the parameters by which these are measured is more
controversial.
The purpose of this survey is to characterize and compare the NICU discharge practice of infants with cardiorespiratory events in the United States, Canada and France.
Assigning cause for sudden unexpected infant death
This article includes multiple AASPP members as authors. It was published online in Forensic Science, Medicine, and Pathology in January of 2015:
Sudden infant death syndrome (SIDS) was originally defined in 1969, focusing attention on sudden death in infants without an identified cause. These infants had a similar age at death and a strong association with sleep in common. Naming the sudden death SIDS instead of calling it ‘‘cause unknown’’ facilitated an enhanced focus on parental support and on research. Later studies identified prone sleep as a significant risk factor for SIDS-classified deaths. The definition of SIDS was expanded in 1991, with an emphasis on scene investigation. Although further modifications have been recommended, no consensus has been achieved. Indeed, a review of recent publications reported that the 1969 definition continues to be used 7% of the time, the 1991 definition 35% of the time, other modifications 26% of the time and in 20% no definition was mentioned. Initially there were no candidate etiologies to explain these deaths. In the intervening years, however, much has been learned about environmental, biological, and genetic risk factors for deaths classified as SIDS. Once prone sleep was identified as a significant risk factor, most developed countries implemented back-to-sleep campaigns. SIDS-classified death rates started to decline after 1990, as did non-SIDS-classified postneonatal mortality rates, and continued to decline until 2001. Much of this decline was initially attributed to an overall decrease in SIDS-classified deaths. Since 2001, however, SIDS-classified death rates have not continued to decrease whereas there has been a diagnostic shift to other assigned causes of sudden unexpected infant death or to unknown cause. Illustrating the impact of how these deaths are classified, SIDS-classified deaths declined by 20% from 2005 to 2011, whereas for the same period the rate of accidental infant deaths increased by 5% and rates for undetermined/unclassified deaths also increased.