Sivanandan Sindhu, Mondal Nivedita
Department of Neonatology, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research, Puducherry.
Department of Neonatology, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research, Puducherry. Correspondence to: Dr Nivedita Mondal, Additional Professor, Department of Neonatology, JIPMER, Puducherry 605 006.
Indian Pediatr. 2022 Oct 15;59(10):778-781. Epub 2022 Aug 10.
To determine the clinical profile and outcome of neonates discharged against medical advice (DAMA) from the neonatal intensive care unit (NICU) of a tertiary care public hospital.
We retrieved information from hospital records of infants who had been discharged against medical advice from the NICU between January, 2016 and December, 2020. This was followed by a telephonic interview to document the infant's outcome.
Out of the 187 (7.7%) neonates that had left DAMA, 165 case records were available, and 65 (39%) families could be contacted telephonically. Congenital malformations accounted for 96 (58%) of the cases; cardiac malformations accounting for 42 (43.7%). 52 (80%) out of the 65 infants had died after median (IQR) 11 (5-35) days of DAMA, and 13 (20%) were alive at a median (IQR) age of 31 (18.5-31.5) months. Post-DAMA medical care was continued at another health facility in 12 (18%).
One out of every five infants was alive for a median age of 31 months after having left DAMA. Mechanisms to ensure continuation of care after DAMA need to be explored.
确定一家三级护理公立医院新生儿重症监护病房（NICU）中违反医嘱出院（DAMA）的新生儿的临床特征及结局。
我们从2016年1月至2020年12月期间NICU违反医嘱出院的婴儿的医院记录中检索信息。随后进行电话访谈以记录婴儿的结局。
在187名（7.7%）违反医嘱出院的新生儿中，有165份病例记录可用，并且通过电话联系到了65个（39%）家庭。先天性畸形占病例的96例（58%）；心脏畸形占42例（43.7%）。65名婴儿中有52名（80%）在违反医嘱出院后的中位（四分位间距）11（5 - 35）天死亡，13名（20%）存活，中位年龄为31（18.5 - 31.5）个月。12名（18%）婴儿在违反医嘱出院后在另一家医疗机构继续接受医疗护理。
每五名婴儿中就有一名在违反医嘱出院后存活，中位年龄为31个月。需要探索确保违反医嘱出院后持续护理的机制。
