News & Commentary

NICU-to-home transition can be tricky


One of the most persistent cost challenges clinician executives at health insurance plans face are those run up at neonatal intensive care units (NICU). When it comes to the well being of infants, no expense should be spared—and usually they aren’t. The last time it looked in 2006, the Institute of Medicine estimated that we spend about $26 billion a year on preterm infants. Managed Care has also looked at this over the years. What we reported in 2010 still holds true: “For managed care organizations, advances in the care of preterm infants create both opportunities and a wide array of societal, ethical, and financial dilemmas.”

New research points out that what happens in the NICU doesn’t necessarily stay in the NICU. These infants will often need continuous care at home and, according to a study by researchers at Case Western Reserve University in Cleveland, that can be when the really difficult part for parents and guardians starts—even more difficult than spending hours each day at the NICU trying to keep despair at arm’s length.

“Technology-dependent neonates require vigilant, complex care and treatment by their parents following discharge from the hospital for continued survival,” says the study, which was presented at a recent conference of the National Association of Pediatric Nurse Practitioners and is slated to be published in Advances in Neonatal Care.

This touches on the difficulties in care transitions, another subject we’ve dealt with. Using a retrospective chart review of 71 neonates from Oct. 1, 2012, to Sept. 30, 2014, who were in the Rainbow Babies & Children’s Hospital Transitional Care Unit in Cleveland, researchers found that 66% of the infants needed supplemental oxygen after discharge and 46.5% needed feeding tubes. Parents need to know how to use those devices, said researchers.

Medical technology used by neonates

Source: Toly VB et al., “Neonates and infants discharged home dependent on medical technology: characteristics and outcomes,” Advances in Neonatal Care (in press).

“Mothers often provide a majority of this care and are at high risk for depression,” the study noted. Maternal distress needs to be monitored, which is where outside health care providers come in. They can “provide needed assessment and support for technology-dependent neonates and their parents during the vulnerable transition period….”

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