Neonatal intensive care unit discharge of infants with cardiorespiratory events: Tri-country comparison of academic centers

Article type: Research Article

Authors: Carlos, C.^{a; b; *} | Hageman, J.^{a; c} | Pellerite, M.^{a; b} | McEntire, B.^d | Cóté, A.^e | Raoux, A.^f | Franco, P.^f | Rusciolelli, C.^c | Consenstein, L.^g | Kelly, D.^h

Affiliations: [a] University of Chicago, Chicago, IL, USA | [b] Department of Pediatrics, Comer Children’s Hospital, Chicago, IL, USA | [c] Department of Pediatrics, NorthShore University Health System, Evanston, IL, USA | [d] American SIDS Institute, Naples, FL, USA | [e] Division of Pediatric Pulmonology, Montreal Children’s Hospital, Montreal, QC, Canada | [f] Pediatric Sleep Unit, Service Epilepsie, Sommeil, Explorations Fonctionnelles Neuropediatriques, Hôpital Femme Mère Enfant, University Lyon, Lyon, France | [g] Department of Pediatrics, St. Joseph Hospital, Syracuse, NY, USA | [h] Department of Pediatrics, Holyoke Medical Center, Mount Holyoke, MA, USA

Correspondence: [*] Corresponding author: Dr. Christine Carlos, Comer Children’s Hospital, University of Chicago, 5721S. Maryland Ave, Chicago, IL 60637, USA. Tel.: +1 773 702 6435; Fax: +1 773 834 0748; Christine.carlos@uchospitals.edu

Abstract: OBJECTIVE:Compare how NICUs within academic centers in Canada, France, and the United States make discharge decisions regarding cardiorespiratory recordings and home use of apnea monitors, oximeters and caffeine. STUDY DESIGN:An anonymous survey was sent to neonatologists through the member listserv of the American Academy of Pediatrics Section on Perinatal Pediatrics, the Canadian Fellowship Program Directory, and to Level 3 NICUs in France. RESULTS:The response rates were 89% , 83% , and 79% for US, Canada and France respectively. In Canada, 45% perform pre-discharge recordings vs. 38% in France and 24% in the US. Apnea free days prior to discharge were required in 100% of centers in Canada, 96% in France, and 92% in the US. In Canada and France, 65% and 68% of units discharge patients on monitors vs. 99% in the US. 64% of the US centers sometimes use home caffeine compared to 40% in Canada and 34% in France. Over 60% of the centers in Canada and France wait until at least 40 weeks post menstrual age to discharge patients, whereas only about 33% of the US wait that late to discharge patients. CONCLUSIONS:Discharge practices from NICUs are not well standardized across institutions or countries. Canada and France keep infants in the hospital longer and are less likely than the US to use home monitoring and home caffeine.

Keywords: Neonatal intensive care unit discharge, neonatal discharge, cardiorespiratory events

DOI: 10.3233/NPM-15814077

Journal: Journal of Neonatal-Perinatal Medicine, vol. 8, no. 4, pp. 307-311, 2015