Harper R G, Sia C G, Spinazzola R, Wapnir R A, Orner S, Harper R
Department of Pediatrics, North Shore University Hospital-Cornell University Medical College, Manhasset, New York 11030.
Pediatrics. 1994 Aug;94(2 Pt 1):190-3.
To determine the privileges of Private Attending Pediatricians (PAP) in caring for newborns requiring intensive (ITC), intermediate (IMC), or continuing (CC) care in Level III neonatal intensive care units (NICUs) throughout the United States.
A two-page mail questionnaire was sent to 429 Level III NICUs to obtain the statement best describing the PAPs' privileges, the number of PAP, and some of the PAPs' functions. Level III NICUs were classified by geographic region as Eastern, Central, or Western United States.
Responses were received from 301 NICUs (70%) representing 48 states, the District of Columbia, and > 9000 PAP. Twenty-two institutions had no PAP. In the remaining 279 institutions, 96% (267/279) had restricted the PAPs' privileges partially or completely. In 32% (88/279), the PAP were not allowed to render any type of NICU care. In 18% (51/279) of the institutions, the PAP were allowed to render CC only. In 27% (76/279) of the institutions, the PAP were allowed to render IMC and CC only. Limitation of PAPs' privileges were reported in all geographic areas in the U.S., were more pronounced in the Eastern than the Central or Western sections of the country, and were noted in institutions with small (< or = 10) as well as large (> or = 60) numbers of PAP. Limitation of PAPs' privileges was determined by the PAP him/herself in many institutions. Proficiency in resuscitation was considered to be a needed skill. Communication with parents of an infant under the care of a neonatologist was encouraged.
The PAPs' privileges were limited partially or completely in most Level III NICUs. Knowledge of this restricted role impacts significantly on curriculum design for pediatric house officers, number and type of health care providers required for Level III NICUs and future house officer's career choices.
确定美国各地三级新生儿重症监护病房（NICU）中，私人执业儿科医生（PAP）在护理需要重症（ITC）、中级（IMC）或持续（CC）护理的新生儿方面的特权。
向429家三级NICU发送了一份两页的邮寄调查问卷，以获取最能描述PAP特权、PAP数量以及PAP一些职能的陈述。三级NICU按地理区域分为美国东部、中部或西部。
收到了来自代表48个州、哥伦比亚特区和9000多名PAP的301家NICU的回复。22家机构没有PAP。在其余279家机构中，96%（267/279）部分或完全限制了PAP的特权。在32%（88/279）的机构中，PAP不被允许提供任何类型的NICU护理。在18%（51/279）的机构中，PAP仅被允许提供CC护理。在27%（76/279）的机构中，PAP仅被允许提供IMC和CC护理。美国所有地理区域均报告了对PAP特权的限制，在东部地区比中部或西部地区更为明显，并且在PAP数量少（≤10）以及数量多（≥60）的机构中均有发现。在许多机构中，PAP特权的限制是由PAP本人决定的。复苏技能被认为是一项必需的技能。鼓励与新生儿科医生护理下的婴儿的父母进行沟通。
在大多数三级NICU中，PAP的特权被部分或完全限制。了解这一受限角色对儿科住院医师的课程设计、三级NICU所需医疗保健提供者的数量和类型以及未来住院医师的职业选择有重大影响。
