Abstract
Background:Survival of infants with complex care has led to a growing population of technology-dependent children. Medical technology introduces additional complexity to patient care. Outcomes after NICU discharge comparing Usual Care (UC) with Comprehensive Care (CC) remain elusive.Objective:To compare the outcomes of technology-dependent infants discharged from NICU with tracheostomy following UC versus CC.Methods:A single site retrospective study evaluated forty-three (N=43) technology-dependent infants discharged from NICU with tracheostomy over 5½ years (2011-2017). CC provided 24-hour accessible healthcare-providers using an enhanced medical home. Mortality, total hospital admissions, 30-days readmission rate, time-to-mechanical ventilation liberation, and time-to-decannulation were compared between groups.Results:CC group showed significantly lower mortality (3.4%) versus UC (35.7%), RR, 0.09 [95%CI, 0.12-0.75], P=0.025. CC reduced total hospital admissions to 78 per 100 child-years versus 162 for UC; RR, 0.48 [95% CI, 0.25-0.93], P=0.03. The 30-day readmission rate was 21% compared to 36% in UC; RR, 0.58 [95% CI, 0.21-1.58], P=0.29). In competing-risk regression analysis (treating death as a competing-risk), hazard of having mechanical ventilation removal in CC was two times higher than UC; SHR, 2.19 [95% CI, 0.70-6.84]. There was no difference in time-to-decannulation between groups; SHR, 1.09 [95% CI, 0.37-3.15].Conclusion:CC significantly decreased mortality, total number of hospital admissions and length of time-to-mechanical ventilation liberation.
Highlights
Survival of infants with complex care has led to a growing population of technology-dependent children
Comprehensive Care (CC) reduced total hospital admissions to 78 per 100 child-years versus 162 for Usual Care (UC); Relative Risks (RR), 0.48 [95% CI, 0.25-0.93], P=0.03
The use of comprehensive care provided in an enhanced medical home can mitigate the patient and caretaker difficulties associated with the care of a technologydependent infant [4]
Summary
A single site retrospective study evaluated forty-three (N=43) technology-dependent infants discharged from NICU with tracheostomy over 51⁄2 years (2011-2017). A single site retrospective chart review was conducted with a cohort of forty-three (N=43) technology-dependent infants. All patients were discharged from Memorial Hermann Children’s Hospital NICU with a diagnosis of tracheostomy dependence. Patients were followed in CC or UC with a pediatrician in the community and pediatric pulmonologist. The decision for an infant to follow UC versus CC was made jointly by family and healthcare team. Both groups were followed by outpatient pediatric Otorhinolaryngology subspecialist (ORL) for tracheostomy evaluation and management. We excluded patients with associated comorbidities that could further contribute to the development of chronic respiratory failure, including: severe Hypoxic-Ischemic-Encephalopathy (HIE), and Central Hypoventilation Syndrome (CCHS). The University of Texas Health Science Center (UTH) institutional review board approved the study
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