Aims NHS England (2015) has outlined Neonatal Intensive Care Unit (NICU) service is for babies who are generally (but not exclusively) less than 44 weeks corrected gestational age (CGA). There are challenges in providing on-going care for these complex infants and their parents beyond this age. There are implications for NICU capacity and service funding. Following a difficult case for our service we conducted this study to assess workload and review the outcomes of babies on NICU beyond 44 weeks.
Methods Eligible babies on NICU between 1/4/2013–31/3/ 2015 were identified from the Standardised Electronic Neonatal Database (SEND) database. Data was collected from the SEND summaries and medical records.
Results Over 2 years, 43 babies were identified, 22 (51%) male and 21 (49%) female. Median birth gestational age was 38+6 (range 23+6–42+2) weeks and birthweight 2650 (500–4300) grams. Duration of NICU stay beyond 44 weeks was 9 (1–153) days. Category of care: 181 days of intensive care (IC), 323 days high dependency (HDC) and 203 days special care. Over this period the service delivered almost 14,000 days IC/HDC care. These babies account for less than 4% of the service workload. Most babies 23 (54%) required on-going TPN administration; 12 (28%) respiratory support and 5 (12%) planned surgery. One baby received Oramorph for neonatal abstinence syndrome, 1 was treated for intractable seizures and 1 with a cardiac anomaly was establishing feeding. Only one child died. Forty two babies survived: 18 (42%) were discharged home; 13 (40%) were transferred back to their local unit; 11 (26%) were transferred to Paediatric Ward or Intensive Care Unit (PICU) in Cambridge. Longer term outcome is known for 17 babies, the further hospital stay was 15(2–130) days. There was one additional death shortly after hospital discharge.
Conclusion This group of babies constitute a small but challenging workload. There are implications for NICU capacity and service funding. We need to work with colleagues and commissioners to identify the most appropriate place to deliver on-going care.
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