Litt Jonathan S, Edwards Erika M, Lainwala Shabnam, Mercier Charles, Montgomery Angela, O'Reilly Deirdre, Rhein Lawrence, Woythaler Melissa, Hartman Tyler
Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Mass.
Vermont Oxford Network, Burlington, Vt.
Pediatr Qual Saf. 2020 May 5;5(3):e287. doi: 10.1097/pq9.0000000000000287. eCollection 2020 May-Jun.
To establish the first regional quality improvement collaborative solely dedicated to follow-through care of high-risk infants after Neonatal intensive care unit (NICU) discharge and to characterize extremely low birth weight (ELBW) follow-up in New England.
Eleven of 14 follow-up programs in New England partnered with the Vermont Oxford Network (VON) ELBW project for an initial data collection project. We collected information about the health status and developmental outcomes of infants born ≤1,000 g or younger than 28 weeks 2014-2016 at the 18-24 months corrected for gestational age (CGA) follow-up visit. VON collected and compiled the data.
Of 993 eligible infants, 516 (52.0%) had follow-up visits. The rehospitalization rate was 33.9%, mostly respiratory illness. Ninety-six children (19.3%) had weight less than 10th percentile and 44 (8.9%) had weight less than third percentile at 18-24 months. Only 170 (61.4%) children had recommended hearing screening after NICU discharge. Forty-six (9.1%) had cerebral palsy; 81 of the 441 infants that completed all 3 sections of the Bayley Scales of Infant Development, third edition (18.4%) had any composite score less than 70. Over half of the social and demographic data were missing.
Most quality initiatives in neonatology stop at NICU discharge. This first project by the New England Follow-up Network showed a low rate for clinical follow-up. It demonstrated many opportunities to improve postdischarge follow-through specific to NICU-based care. Future projects will aim to improve the quality of follow-through services through collaborative learning, data sharing, and comparative outcomes.
建立首个专门致力于新生儿重症监护病房（NICU）出院后高危婴儿后续护理的区域质量改进协作组织，并描述新英格兰地区极低出生体重（ELBW）婴儿的随访情况。
新英格兰地区14个随访项目中的11个与佛蒙特牛津网络（VON）的ELBW项目合作开展了一项初始数据收集项目。我们收集了2014 - 2016年出生时体重≤1000克或孕周小于28周的婴儿在矫正胎龄（CGA）18 - 24个月随访时的健康状况和发育结局信息。VON收集并整理了这些数据。
在993名符合条件的婴儿中，516名（52.0%）进行了随访。再住院率为33.9%，主要是呼吸系统疾病。96名儿童（19.3%）在18 - 24个月时体重低于第10百分位数，44名（8.9%）体重低于第3百分位数。NICU出院后只有170名儿童（61.4%）接受了推荐的听力筛查。46名（9.1%）患有脑瘫；在完成贝利婴儿发展量表第三版所有三个部分的441名婴儿中，81名（18.4%）的任何综合得分低于70。超过一半的社会和人口统计学数据缺失。
新生儿学中的大多数质量改进举措在NICU出院时就停止了。新英格兰随访网络的首个项目显示临床随访率较低。它展示了许多改善基于NICU护理的出院后后续护理的机会。未来的项目将旨在通过协作学习、数据共享和比较结果来提高后续护理服务的质量。
