RT Book, Section
A1 Malcolm, William F.
SR Print(0)
ID 1105545037
T1 Essential Components of a Comprehensive Follow-Up Clinic
T2 Beyond the NICU: Comprehensive Care of the High-Risk Infant
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-174858-2
LK accesspediatrics.mhmedical.com/content.aspx?aid=1105545037
RD 2024/04/19
AB Need  for  a  comprehensive  follow-up  clinicMany  extremely  premature  infants  and  critically  ill  term  infants  survive  to  be  discharged  home  with  a  complex  mix  of  pulmonary,  cardiac,  gastrointestinal,  endocrine,  and  neurologic  problems,  all  of  which  may  have  a  major  impact  on  their  overall  health,  growth,  and  development.Few  general  pediatricians  and  family  medicine  physicians  have  the  training,  experience,  and  availability  to  optimally  care  for  these  medically  fragile  NICU  graduates  during  their  most  vulnerable  first  years  of  life.With  delayed  or  ineffective  care,  acute  illnesses  or  complications  can  quickly  develop  into  severe,  even  life-threatening  problems.  Additionally,  feeding  and  nutritional  difficulties  can  lead  to  failure  to  thrive  in  these  fragile  infants,  necessitating  rehospitalization  and  additional  medical  costs.Definition  of  a  pediatric  medical  homeThe  American  Academy  of  Pediatrics  (AAP)  believes  that  the  medical  care  of  infants  ideally  should  be  accessible,  continuous,  comprehensive,  family  centered,  coordinated,  compassionate,  and  culturally  effective.  These  characteristics  define  the  pediatric  medical  home.It  should  be  delivered  or  directed  by  well-trained  physicians  who  provide  primary  care  and  help  manage  and  facilitate  essentially  all  aspects  of  pediatric  care.The  physician  should  be  known  to  the  child  and  family  and  should  be  able  to  develop  a  partnership  of  mutual  responsibility  and  trust  with  them.What  we  ask  of  primary  care  providersWhen  assuming  the  care  after  discharge  of  an  extremely  medically  fragile  infant  with  multiple  chronic  medical  problems,  the  primary  care  physician  (PCP)  has  a  great  challenge.In  order  to  provide  the  continuous,  coordinated,  and  comprehensive  care  required  from  a  pediatric  medical  home,  the  PCP  must  stay  up  to  date  on  many  aspects  of  neonatal  care  includingNeonatal  technologies  and  therapies  utilized  in  the  NICUIndications  for  a  wide  variety  of  medications  including  drug  doses,  toxicities,  and  laboratory  tests,  which  must  be  followed  to  ensure  that  the  drugs  are  working  and  remain  safe  for  the  childSpecial  formulas  indicated  for  premature  infants  and  infants  with  various  intestinal  and  digestive  problems  as  well  as  special  recipes  and  additives  needed  for  proper  growth  and  nutritionIndications,  operation,  and  troubleshooting  for  a  variety  of  different  types  of  medical  equipment  such  as  oxygen  by  nasal  cannula,  supplemental  nasogastric,  gastrostomy  or  jejunal  tube  feedings,  ventriculoperitoneal  shunt,  ileostomy  and  colostomy  tracheostomy,  cardiopulmonary  monitor  and  oximeter,  laptop  ventilatorProviding  this  comprehensive  and  complex  care  also  requires  increased  office  visit  time  and  frequency  for  the  primary  care  provider.  Barriers  to  providing  this  necessary  care  includeDecreased  training  time  for  residents  in  high  risk  infant  convalescent  care  and  discharge  planningFew  formal  update  courses  for  pediatricians  and  family  medicine  physicians  in  the  care  of  medically  fragile  infantsInadequate  reimbursement  from  insurance  for  the  increased  time  required  to  provide  adequate  care  to  infants  with  complex  medical  problemsWhat  we  ask  of  parentsWhen  medically  fragile  infants  are  discharged  from  the  NICU  with  complex  medical  problems,  parents  are  expected  to  assume  a  great  deal  of  responsibility  in  caring  for  their  infants  with  very  little  medical  knowledge  or  training.Specifically  parents  are  expected  toAdminister  a  variety  of  medications  with  different  dosing  schedules  and  fractional  dosing  amountsMix  formulas  to  increased  caloric  densities  and/or  add  formula  or  other  additives  to  breast  milkFollow  recommended  feeding  schedules  and  strategies  to  ...