RESUMO
BACKGROUND: Outborn infants born at community hospitals and transported to tertiary neonatal intensive care units (NICUs) for treatment account for 20% of all tertiary NICU admissions in Canada. Little is known about variations in their outcomes. The Transport Risk Index of Physiologic Stability (TRIPS) is a validated score of neonatal physiological status that can identify differences between transport teams' outcomes. OBJECTIVE: To examine regional variations in outcomes among outborn infants transported to Canadian tertiary NICUs using TRIPS. DESIGN AND METHODS: Transport teams prospectively collected data for all outborn infants admitted to 25 Canadian NICUs during 2006 to 2007. Singleton outborn infants ≥ 32 weeks' gestation admitted to NICUs for at least 24 hours who died or who were transferred to another NICU within 24 hours were examined for overall incidence of mortality, major morbidity, and change in TRIPS score. RESULTS: Complete transport data were available for 2313 (72.9%) of 3193 eligible infants. There were significant variations in interhospital and interprovincial outcomes. Factors significantly affecting change in TRIPS score were gender, pretransport TRIPS score, composition of transport team and distance traveled. CONCLUSION: Significant variation exists in transport outcomes in Canada. Further investigation is required to optimize infant transport systems, processes, and clinical care.
Assuntos
Unidades de Terapia Intensiva Neonatal , Equipe de Assistência ao Paciente/estatística & dados numéricos , Transporte de Pacientes , Pressão Sanguínea , Temperatura Corporal , Canadá , Feminino , Geografia , Hospitais Comunitários , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Avaliação de Resultados em Cuidados de Saúde , Oximetria , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Centros de Atenção TerciáriaRESUMO
PURPOSE: To describe the clinical properties and psychometric soundness of infant oral motor feeding assessments available for practice. METHODS: A systematic review was conducted using six databases (PubMed, Ovid [Medline], CINHAL, EMBASE, psycINFO, and COCHRANE) to retrieve articles. Assessments were analyzed for their clinical characteristics and psychometric robustness. RESULTS: Ten assessment tools were identified to meet the inclusion/exclusion criteria. Clinical properties of the tools varied from assessments which assessed oral feeding readiness, oral motor function, and pre-feeding skills for breast and/or bottle feeding. Psychometric evidence was found for seven assessment tools. The Neonatal Oral Motor Assessment Scale was found to be the most widely tested for psychometric soundness. The overall psychometric evidence was inconsistent and/or inadequate for the evaluative tools. CONCLUSIONS: Findings from this systematic review demonstrate clinical usefulness of the tools based on their assessment properties, however additional studies are needed to further establish their psychometric soundness.