Department of Pediatrics, Stanford University, Stanford, California.
Department of Pediatrics, University of California San Francisco, San Francisco, California.
Hosp Pediatr. 2023 Mar 1;13(3):208-216. doi: 10.1542/hpeds.2022-006882.
Late preterm and term infants comprise 97.3% of annual births in the United States. Admission criteria and the availability of medical interventions in well newborn nurseries are key determinants of these infants remaining within a mother-infant dyad or requiring a NICU admission and resultant separation of the dyad. The objective of this study was to identify national patterns for well newborn nursery care practices.
We surveyed a physician representative from each nursery in the Better Outcomes through Research for Newborns Network. We described the admission criteria and clinical management of common newborn morbidities and analyzed associations with nursery demographics.
Of 96 eligible nursery representatives, 69 (72%) completed surveys. Among respondents, 59 (86%) used a minimal birth weight criterion for admission to their well newborn nursery. The most commonly used criteria were 2000 g (n = 29, 49%) and 1800 g (n = 19, 32%), with a range between 1750 and 2500 g. All nurseries used a minimal gestational age criterion for admission; the most commonly used criterion was 35 weeks (n = 55, 80%). Eleven percent of sites required transfer to the NICU for phototherapy. Common interventions in the mother's room included dextrose gel (n = 56, 81%), intravenous antibiotics (n = 35, 51%), opiates for neonatal abstinence syndrome (n = 15, 22%), and an incubator for thermoregulation (n = 14, 20%).
Wide variation in admission criteria and medical interventions exists in well newborn nurseries. Further studies may help identify evidence-based optimal admission criteria to maximize care within the mother-infant dyad.
在美国，晚期早产儿和足月婴儿占每年出生人数的 97.3%。新生儿重症监护病房的入院标准和医疗干预措施的可用性是这些婴儿留在母婴二人组内还是需要新生儿重症监护病房入院并导致二人组分离的关键决定因素。本研究的目的是确定全美新生儿重症监护病房护理实践的模式。
我们对每个新生儿重症监护病房的医生代表进行了调查Better Outcomes through Research for Newborns 网络。我们描述了常见新生儿疾病的入院标准和临床管理，并分析了与新生儿重症监护病房人口统计学特征的关联。
在 96 名符合条件的新生儿重症监护病房代表中，有 69 名（72%）完成了调查。在回答者中，59 名（86%）使用最小出生体重标准来确定其新生儿重症监护病房的入院标准。最常用的标准是 2000 克（n = 29，49%）和 1800 克（n = 19，32%），范围在 1750 至 2500 克之间。所有新生儿重症监护病房都使用最小胎龄标准来确定入院标准；最常用的标准是 35 周（n = 55，80%）。有 11%的医院需要将新生儿转至新生儿重症监护病房进行光疗。母亲病房中常见的干预措施包括葡萄糖凝胶（n = 56，81%）、静脉内抗生素（n = 35，51%）、治疗新生儿戒断综合征的阿片类药物（n = 15，22%）和用于体温调节的孵化器（n = 14，20%）。
新生儿重症监护病房的入院标准和医疗干预措施存在广泛差异。进一步的研究可能有助于确定基于证据的最佳入院标准，以最大限度地提高母婴二人组内的护理效果。
