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.

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