The Effect of Comprehensive Medical Care on the Long-Term Outcomes of Children Discharged from the NICU with Tracheostomy

• Published in: The open respiratory medicine journal 2018, Vol.12 (1), p.39-49
• Main Authors: De Jesus-Rojas, Wilfredo, Mosquera, Ricardo A, Samuels, Cheryl, Eapen, Julie, Gonzales, Traci, Harris, Tomika, McKay, Sandra, Boricha, Fatima, Pedroza, Claudia, Aneji, Chiamaka, Khan, Amir, Jon, Cindy, McBeth, Katrina, Stark, James, Yadav, Aravind, Tyson, Jon E
• Format: Article
• Language: English
• Subjects: Respiratory Medicine
• ISSN: 1874-3064; 1874-3064
• DOI: 10.2174/1874306401812010039

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. To compare the outcomes of technology-dependent infants discharged from NICU with tracheostomy following UC versus CC. 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. 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]. CC significantly decreased mortality, total number of hospital admissions and length of time-to-mechanical ventilation liberation.