Farel A, Kotelchuck M, Metzguer K, Fullar S
Department of Maternal and Child Health, University of North Carolina, Chapel Hill 27599-7400.
J Perinatol. 1993 Mar-Apr;13(2):132-6.
Severe crowding in neonatal intensive care facilities may prevent many critically ill newborn infants from receiving optimal care. Crowding could be alleviated by back transferring chronically ill or convalescing infants to intermediate-level community hospitals where community-based care can be delivered. The purpose of this study was to assess the ability of such hospitals in North Carolina to care for these children. A telephone survey was administered to all 35 intermediate-level community hospitals that had > or = 600 births per year. Hospital resources were assessed on the first call, and a 1-day census was taken for three successive months. Total daily nursery census was 288. Back-transferred infants (32) and infants whose stay exceeded 5 days (32) constituted 24% of the nursery population. Each hospital had a pediatric medical director and necessary equipment to care for back transfers, and 80% of the hospitals could accept a back-transferred infant who was in a neonatal incubator, tube fed, receiving oxygen, 1400 gm, with mild and infrequent apnea and bradycardia--a common clinical picture in such infants. The most severe limitation to accepting infants for back transfer was the shortage of nursing staff appropriately trained to care for this population. These data have implications for effective discharge planning and the development of appropriate community-based, service-delivery systems.
新生儿重症监护病房的严重拥挤可能会使许多危重新生儿无法得到最佳护理。将慢性病患儿或正在康复的婴儿转回中级社区医院，在那里可以提供社区护理，这样可以缓解拥挤状况。本研究的目的是评估北卡罗来纳州此类医院照顾这些儿童的能力。对每年分娩量≥600例的所有35家中级社区医院进行了电话调查。首次电话调查时评估了医院资源，并连续三个月进行了为期1天的人口普查。每日托儿所总普查人数为288人。转回的婴儿（32名）和住院时间超过5天的婴儿（32名）占托儿所人口的24%。每家医院都有一名儿科医疗主任和照顾转回婴儿所需的设备，80%的医院能够接收一名处于新生儿保育箱中、通过鼻饲管进食、吸氧、体重1400克、有轻度且不频繁呼吸暂停和心动过缓症状的转回婴儿，这是此类婴儿常见的临床表现。接收转回婴儿最严重的限制因素是缺乏经过适当培训以照顾这类人群的护理人员。这些数据对有效的出院计划以及合适的社区服务提供系统的发展具有启示意义。
