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A review of guidelines for the discharge of premature infants: opportunities for improving cost effectiveness.

Authors
Type
Published Article
Journal
Journal of perinatology : official journal of the California Perinatal Association
Publication Date
Volume
18
Issue
6 Pt 2 Su
Identifiers
PMID: 10023377
Source
Medline
License
Unknown

Abstract

Although significant advances in the medical management of acutely ill preterm infants has resulted in unprecedented rates of survival, issues surrounding the convalescent care, discharge preparation, and readiness of parents or other caregivers has been less well studied and represents the art of medicine. We have summarized various guidelines for early discharge of the premature infant and provide our own recommendations for physiologic stability, social requirements, teaching needs of caregivers, and the coordination of community resources. Technology-dependent infants pose even greater complexities. Some infants and families adapt to extensive use of technology in the home. In other situations, basic infant care is difficult to achieve. What are the essential components for successful early discharge, and how can the studies involving selecting families be made universal? How can NICUs better prepare fathers and mothers for premature parenthood? To what extent are we overwhelming families with additional responsibilities and expectations that may compromise their competency in basic parenting? Furthermore, the degree of provider variation in evaluating and providing for discharge planning is now being more carefully studied. In some circumstances, integrated teams in the NICU have facilitated the discharge process, saving days of hospitalization, whereas in other circumstances, adherence to discharge planning guidelines have lengthened the stay in the NICU and resulted in higher costs. Failure to back transport infants to community NICUs has contributed to deregionalization efforts in some regions and increased cost of care. Efforts to establish regional referral networks with common guidelines and developmentally focused care should lead to a reduction in NICU costs and charges.

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