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Premature infants with chronic lung disease can be safely cared for by community-based providers coordinating with a nurse specialist

Premature infants with chronic lung disease (CLD) are prone to frequent respiratory illnesses, feeding difficulties, growth failure, and rehospitalization during infancy. They are also more likely than other infants to suffer from cognitive, motor, and language impairment, and hearing loss. After discharge from a neonatal intensive care unit (NICU), these infants benefit from comprehensive and coordinated care such as that typically provided by sophisticated medical centers, yet such centers may not be accessible for some families.

However, a new study shows that premature infants with CLD can fare as well after NICU discharge when followup care is provided by community-based providers, with a nurse specialist coordinating the child's care and maintaining frequent telephone contact with the family. For rural families or those distant from medical centers, community-based care might be a preferred alternative, suggests T. Michael O'Shea, M.D., M.P.H., of Wake Forest University School of Medicine.

Dr. O'Shea and colleagues randomly assigned 150 premature infants with CLD to either community-based (75 infants) or medical center-based (75 infants) followup care. The researchers measured infant outcomes based on mental and psychomotor developmental indexes, a behavioral scale, evidence of growth delay (less than 5th percentile of weight for length) at 1 year of age, and respiratory rehospitalizations. In each group, 73 infants survived and 69 were evaluated at 1 year. The median mental development index (corrected for gestational age) was 90 for both groups. The median psychomotor developmental index, behavior composite, and rehospitalization rate for respiratory illness were similar for center-based and community-based groups (82 vs. 81, 100 vs. 102, and 33 vs. 29 percent, respectively).

Although not statistically significant, twice as many infants receiving community-based care than those receiving center-based care had growth delay (26 vs. 13 percent). This difference may have been due to more accurate pulse oximetry measures of an infant's minimum oxygen saturation during sleep in the clinic than in the home, leading to more optimal supplemental oxygen needed for growth.

The study was supported in part by the Agency for Healthcare Research and Quality (HS07928).

See "followup care for infants with chronic lung disease: A randomized comparison of community- and center-based models," by Dr. O'Shea, Savithri Nageswaran, M.B.B.S., M.P.H., Debbie C. Hiatt, B.S.N., R.N., and others, in the April 2007 Pediatrics 119(4), pp e947-e957.

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