This research examines the safety and cost effectiveness of an institutional policy on discharge of preterm infants with Apnea of Prematurity (AOP) from the Virginia Commonwealth University Medical Center Newborn Intensive Care Unit (VCUNC NICU) with caffeine therapy and a cardiorespiratory monitor. This practice policy was developed over a decade ago as a cost containment measure in neonatal care and continues to be implemented today despite the lack of a formal evaluation. The secondary objective was to examine through a review of the literature the psychosocial impact of premature birth on the family and the potential effect on the infant's hospital discharge. The evaluation of this policy is based on the conceptual framework of effectiveness, efficiency, and equity in health care. Results were used to generate policy recommendations.This is a retrospective case study of 933 infants admitted to the VCU Medical Center and the community hospital NICU between 1993 and 2002 diagnosed with Apnea of Prematurity. Data was obtained from the Neonatal Information System database at Virginia Commonwealth University Health System (VCUHS), the Virginia Department of Health, and the VCUHS hospital information system. In this mixed methods study, the infants were divided into two groups: 1) those discharged from the hospital on caffeine citrate therapy, and a cardiorespiratory monitor for continued management of apnea; and 2) those that were hospitalized until resolution of apnea. Data was analyzed for differences in mortality and morbidity, hospital readmissions and cost of hospital care from birth to 1 year of age. Interviews were conducted with NICU clinicians to obtain a qualitative perspective on this policy. No significant differences were found in the mortality rate between the two groups (p=.65), and the causes of the four deaths were unrelated to Apnea of Prematurity. Mean hospital costs were approximately $58,000 in both groups. Bronchiolitis was the leading cause for hospital readmission and there was no difference in the rate of hospital readmissions. Based on interviews with NICU clinicians, the policy works well and early discharge is advantageous to the infant and family. Therefore, we find no reason to not continue this policy. Study results support the importance and direction for further research on early discharge of infants with AOP and enhanced epidemiologic surveillance of this population.

Made available in DSpace on 2016-08-19T18:16:02Z (GMT). No. of bitstreams: 1 Christiana Leal Salgado.pdf: 2220876 bytes, checksum: 73b3f7e0a903e6f67511018a8a8243df (MD5) Previous issue date: 2010-10-19 / This paper aims to analyze the experience of young children s families in the face of an intensive Care Unit of Cardiology s internment. The presence of parents in the hospital environment contributes to minimize the suffering caused by the child's hospitalization. Understanding the factors that help parents when facing the context of disease treatment and hospitalization of a child can help them to understand the dynamic factors related to hospital, helping them to better cope with the situation of illness, treatment and hospitalization. Qualitative approach was the methodological option, considering the nature of study s subject. Were accomplished six semistructured interviews with mothers and a father besides 100 hours of participant observation during the study, 20 hours of it dedicated to formal observation. We used the thematic analysis, a method of content analysis to understand the data. The results were classified into four units of meaning: feelings and emotions against the child's illness; heart disease under the maternal staring; the mother and child in the dynamics of the Intensive Care Unit; resources to face the situation; It follows that the heart s symbolism enhances the mothers emotional fragility regarding their children's illness; religiosity; spirituality and a consistent social support network were contributing factors for demonstration and maintenance of adaptive behavior. The presence of the mother and her stay in all stages of children s treatment in the studied Unit does not always happen. / Este trabalho objetiva analisar a vivência de famílias de crianças frente à internação em uma Unidade de Terapia Intensiva Cardiológica. A presença dos pais no ambiente hospitalar contribui para a minimização do sofrimento gerado na criança pela internação. A compreensão dos fatores que auxiliam os pais no enfrentamento diante do contexto doença-tratamento e hospitalização do filho pode ajudá-los a compreender os fatores ligados à dinâmica hospitalar, contribuindo para um melhor enfrentamento da situação de adoecimento, tratamento e hospitalização. A abordagem qualitativa foi a opção metodológica, considerando-se a natureza do objeto de estudo. Foram realizadas seis entrevistas semi-estruturadas com as mães e uma com o pai e 100 horas de observação participante durante o estudo, sendo 20 horas de observação formal. Foi utilizada a análise temática, uma modalidade da análise de conteúdo para a compreensão dos dados. Os resultados foram classificados em quatro núcleos de sentido: sentimentos e emoções frente ao adoecimento do filho; a doença do coração sob o olhar materno; a mãe e o filho na dinâmica da Unidade de Terapia Intensiva; recursos de enfrentamento; Concluiu-se que o simbolismo do coração potencializa a fragilidade emocional das mães diante do adoecimento dos seus filhos; a religiosidade, a espiritualidade e uma consistente rede social de apoio foram fatores contribuintes para a emissão e a manutenção de comportamentos adaptativos. A presença da mãe e a sua permanência em todas as etapas do tratamento da criança, na Unidade estudada, nem sempre acontece.