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Outcomes of Neonates With Complex Medical Needs

Kieran, Emily MD, PhD; Sara, Rahnuma BSc; Claydon, Jennifer MSc; Hait, Valoria MSc; de Salaberry, Julie MSc; Osiovich, Horacio MD; Shivananda, Sandesh MD, MSc, FRCPC

Section Editor(s): Forsythe, Paula L.

doi: 10.1097/ANC.0000000000000639
Outcomes of Neonatal Care

Background: Children with complex medical needs (CMN) are high healthcare resource utilizers, have varying underlying diagnoses, and experience repeated hospitalizations. Outcomes on neonatal intensive care (NICU) patients with CMN are unknown.

Purpose: The primary aim is to describe the clinical profile, resource use, prevalence, and both in-hospital and postdischarge outcomes of neonates with CMN. The secondary aim is to assess the feasibility of sustaining the use of the neonatal complex care team (NCCT).

Methods: A retrospective cohort study was conducted after implementing a new model of care for neonates with CMN in the NICU. All neonates born between January 2013 and December 2016 and who met the criteria for CMN and were cared for by the NCCT were included.

Results: One hundred forty-seven neonates with a mean (standard deviation) gestational age of 34 (5) weeks were included. The major underlying diagnoses were genetic/chromosomal abnormalities (48%), extreme prematurity (26%), neurological abnormality (12%), and congenital anomalies (11%). Interventions received included mechanical ventilation (69%), parenteral nutrition (68%), and technology dependency at discharge (91%). Mortality was 3% before discharge and 17% after discharge. Postdischarge hospital attendances included emergency department visits (44%) and inpatient admissions (58%), which involved pediatric intensive care unit admissions (26%).

Implications for Practice: Neonates with CMN have multiple comorbidities, high resource needs, significant postdischarge mortality, and rehospitalization rates. These cohorts of NICU patients can be identified early during their NICU course and serve as targets for implementing innovative care models to meet their unique needs.

Implications for Research: Future studies should explore the feasibility of implementing innovative care models and their potential impact on patient outcomes and cost-effectiveness.

Division of Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada (Drs Kieran, Osiovich, and Shivananda and Mss Claydon, Hait, and de Salaberry); and Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada (Drs Kieran, Osiovich, and Shivananda and Mss Sara and Claydon).

Correspondence: Sandesh Shivananda, MD, MSc, FRCPC, Division of Neonatology, BC Women's Hospital and Health Centre, 4500 Oak St, Room No. 1R-19, Vancouver, BC V6H 3V4, Canada (

The authors thank Marissa Gibbard for review of the manuscript. The authors thank all past and present members of neonatal complex care teams for their commitment, dedication, and untiring efforts to improve the care of neonates with complex medical needs. The authors thank all BCWH NICU neonatologists, house staff, allied staff, and point-of-care providers, senior executives as well as BC Children's Hospital subspecialists for encouragement and support while implementing the complex care team model.

All authors have no conflicts of interest to disclose.

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© 2019 by The National Association of Neonatal Nurses