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Yet another 'pick your brain' survey for PICU, NICU-NET, &
PED-EM-L readers. Please respond directly to me w/your views:
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It has been proposed that infants <= 14d of age be admitted to
our Intensive Care Nursery (formerly called NICU, a combined
Level III + grower unit) from home or Emergency Departments
(not just L&D or outlying nurseries) if they need intensive
care for "conditions of perinatal origin" (e.g. congenital
malformations including cardiopulmonary problems, problems
occurring w/in 72 hrs of nursery discharge, or newborn
problems previously detected when longer newborn stays were
standard, such as poor feeding, metabolic defects, etc.).
With distinct isolation beds in a new ICN currently under
construction, it is proposed that even babies with potential
viral infections such as varicella and RSV could be
accommodated in the future.
 
Previously, only very young premature or fullterm neonates
from a generally 'clean' environment (Labor & Delivery suite,
newborn nursery, Level 2 and 3 NICUs, etc.) were admitted to
the NICU, and cared for by neonatal team of physicians,
nurses, RTs, etc up until the time of discharge home.  Those
from 'dirty' sources (even scant hours out of the hospital)
were admitted to the pediatric ward or Pediatric ICU,
depending on severity of illness, where their care was
provided by general pediatric, pediatric critical care, or
other pediatric subspecialty teams, based on their clinical
needs.
 
Which leads to curiosity as to what happens or is thought
elsewhere:
1)   Are young infants admitted to the Neonatal unit at your
     institution from locations other than Delivery or Nursery
     areas?  In which of the following concrete situations?
     a) "Significant" apnea event on way home from the
     fullterm Nursery?  A premie leaving the NICU?
     b) Home 3d, breastfeeding poorly, readmitted for
     hypoglycemia and phototherapy?
     c) From outside ER, a 2-week old (fullterm, home since
     DOL 2), presenting w/resp failure & shock, presumed to be
     sepsis?
     d) 5 day-old in private pediatrician's office w/dyspnea,
     cyanosis, hepatomegaly, & murmur?
 
2)   Strengths/Weaknesses of caring for this new class of
     babies in a neonatal unit?
 
3)   TRUE/FALSE:  Much of the conventional paranoia about
     infection control in newborn units (Level I, II, or III)
     is unfounded.
 
4)   Strengths/Weaknesses of caring for these babies in a
     Pediatric ICU (if critically ill)?
 
5)   If this were my child/grandchild, I would want...
 
To debate this as a Quality of Care issue rather than as a
"turf war", your collective well-reasoned thoughts/opinions
would be greatly appreciated.  Please mention your hospital's
name & your specialty, so I can track redundant experiences.
I will post a summary of anonymous responses when they trickle
out.  Minimize bandwidth clutter;  please respond directly to
me:
 
 [log in to unmask]                         Steve Klem, M.D.