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A Catlin Journal of Perinatology. 2006; 26: 742-748 Apresentação: Ana Marily Soriano Ricardo

Hospitalização Neonatal Extremamente Prolongada ( Extremely long hospitalization of newborns in the United States: Data, descriptions, dilemmas ). A Catlin Journal of Perinatology. 2006; 26: 742-748 Apresentação: Ana Marily Soriano Ricardo Unidade de Neonatologia do HRAS/SES/DF

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A Catlin Journal of Perinatology. 2006; 26: 742-748 Apresentação: Ana Marily Soriano Ricardo

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  1. Hospitalização Neonatal Extremamente Prolongada(Extremely long hospitalization of newborns in the United States: Data, descriptions, dilemmas) A Catlin Journal of Perinatology. 2006; 26: 742-748 Apresentação: Ana Marily Soriano Ricardo Unidade de Neonatologia do HRAS/SES/DF www.paulomargotto.com.br

  2. INTRODUÇÃO • EUA, 2003: 4 052 000 nascidos vivos. • 12% Prematuros • 1,5% menores 1500g • 3% Defeitos congênitos • Tecnologia: salvar RN que morreriam precocemente.

  3. INTRODUÇÃO • Smith e Uphoff (2001): Único estudo publicado sobre hospitalização prolongada. • “Morar no hospital” Crescendo no hospital!

  4. OBJETIVO • Investigar a situação nos EUA dos RN que passaram por hospitalização prolongada ou que não eram possibilitados de receberem alta hospitalar. • Condições causais, situação dos familiares e prestadores de serviço ( médicos e enfermeiras).

  5. MÉTODOS • Estudo descritivo • Método da triangulação: • HCUP – KID • LONGTERM • Questão descritiva – não era identificado o paciente e/ou profissional participante.

  6. MÉTODOS • HCUP – KID • Programa criado para avaliar todos os nascimentos durante o ano de 2003 com período de hospitalização maior que 179 dias. • Amostras randomizadas de 36 estados participantes.

  7. MÉTODOS • LONGTERM • Questionário desenvolvido para os profissionais de saúde. • Diagnóstico • Peso de nascimento • Idade gestacional • Condições maternas • Condições neonatais

  8. MÉTODOS • Questão descritiva: • Descrever seus pensamentos, sentimentos ou conceitos sobre a criança hospitalizada.

  9. RESULTADOS • HCUP – KID • 680 RN hospitalizados por mais de 179 dias. • 58% sexo masculino • 44% alta hospitalar sem seqüelas • 27% alta com cuidados de enfermagem • 13% transferência unidades semi – intensivas • 16% morte hospitalar

  10. RESULTADOS • HCUP – KID • 680 RN hospitalizados por mais de 179 dias. • 78 diagnósticos • 56% DBP • 50% lesão pulmonar crônica • 44% sepse • 40% prematuridade + icterícia • 25% ECN • 41% PT extrema • Mais comum: 228 dias / P~1470g.

  11. RESULTADOS • LONGTERM • 442 questionários completos • 69% enfermeiras • 10% médicos • 1% assistentes sociais • 19% outros • 422 RN hospitalizados por mais de 179 dias

  12. RESULTADOS • LONGTERM • 60% sexo masculino • 32% alta hospitalar sem seqüelas • 25% permaneciam internadas UTIN / UTIP • 13% transferência unidades semi – intensivas • 30% morte hospitalar

  13. RESULTADOS • LONGTERM • 53% <1000g • 23% 1000g – 2499g • 25% > 1500g • 28% IG 24 sem • 20% RNT • 21% DHEG ( condição materna mais associada)

  14. RESULTADOS

  15. RESULTADOS

  16. RESULTADOS

  17. RESULTADOS • Questão descritiva • 288 respostas • Não é correto • A patologia nos prende • Proporcionar uma vida normal • Encontrar um lugar adequado • Quem é o responsável? • Custos

  18. RESULTADOS

  19. DISCUSSÃO • Davison et al (1994): hospitalização prolongada em RNPT com DBP, ECN. • Cotton et al (2005): estudo multicêntrico com 685 RN, hospitalizados entre 99 – 734 dias. • ECN, DBP, sepse

  20. DISCUSSÃO • Beckstrand et al (2006), Elpern et al (2005), Hefferman e Heiling (1999): • Descrevem o estresse moral de fornecer tratamentos agressivos para pacientes que já não se beneficiariam com o tratamento.

  21. DISCUSSÃO • Solomon et al (2005): “ Estamos salvando crianças que não deveriam ser salvas”

  22. CONCLUSÃO • O bom tratamento paliativo que visa QUALIDADE de vida, mais do que o TEMPO de vida , continua sendo o foco principal!

  23. Referências do artigo: • Center for Disease Control. National Center for Birth Defects and Developmental Disabilities 2003, http://www.cdc.gov/ncbddd/bd/faq1.htm, CommonBD. • National Vital Statistics. CDC http://www.cdc.gov/nchs/fastats/birthwt.htm. • Hegarty J, Abrams EJ, Hutchinson VE, Nicholas SW, Suarez MS, Heagarty MC. The medical care cost of human immunodeficiency virus-infected children in Harlem. JAMA 1988; 260(13): 1901–1905. | Article | PubMed | • Smith K, Uphoff ME. Charting uncharted terrain: problems born in the NICU grow up in the PICU. J Clin Ethics 2001; 12(3): 231–238. | PubMed | • Miles MB, Huberman AM. Qualitative Data Analysis: An Expanded Sourcebook. Sage: Thousand Oaks, CA, 1994. • Cotton CM, Oh W, McDonald S, Carlo W, Fanaroff AA, Duara S et al. Prolonged hospital stay for extremely premature infants. J Perinatol 2005; 25(10): 650–655. | Article | PubMed | • Davison T, Karp W, Kanto W. Clinical characteristics and outcomes of infants requiring long-term neonatal intensive care. J Perinatol 1994; 14(6): 461–466. | PubMed | • Newburger JW, Wypij D, Bellinger DC, du Plessis AJ, Kuban KCK, Rappaport LA et al. Length of stay after infant heart surgery is related to cognitive outcome at age 8 years. J Pediatr 2003; 143(1): 67–73. | Article | PubMed | • Bisquera JA, Cooper TR, Berseth C. Impact of necrotizing enterocolitis on length of stay and hospital charges in very low birth weight infants. Pediatrics 2002; 109(3): 423–428. | Article | PubMed | • Payne N, Carpenter JH, Badger GJ, Hobar JD, Rogowski J. Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants. Pediatrics 2004; 114(2): 348–355. | Article | PubMed | ISI |

  24. Briassoulis G, Filippou O, Natsi L, Mavrikiou M, Hatzis T. Acute and chronic paediatric intensive care patients: current trends and perspectives on resource utilization. QJM 2004; 97: 507–518. | Article | PubMed | • Meadow W, Lee G, Lin K, Lantos J. Changes in mortality for extremely low birth weight infants in the 1990's: Implications for treatment decisions and resource use. Pediatrics 2004; 113(5): 1223–1229. | Article | PubMed | • Marcin J, Slonim AD, Pollack MM, Ruttimann UE. Long term stay in the pediatric intensive care unit. Crit Care Med 2001; 29(3): 652–657. | Article | PubMed | • Evans R, Madsen B. Culture clash: transitioning from the neonatal intensive care unit to the pediatric intensive care unit. Newborn Infant Nurs Rev 2005; 5(4): 188–193. | Article | • Ross M, Downey CA, Bemis-Heys R, Nguyen M, Jacques DL, Stanziano G. Prediction of maternal risk factors of neonatal intensive care admissions: evaluation of >59 000 women in national managed care programs. Am J Obstetr Gynecol 1999; 181(4): 835–842. | Article | • Ray LD. Categorical service allocation and barriers to care for children with chronic conditions. Can J Nurs Res 2005; 37(3): 86–102. | PubMed | • Hummel P, Cronin J. Home care of the high risk infant. Advan Neonat Care 2004; 4(6): 354–364. | Article | • Catlin A. Home care for the high risk neonate: success or failure depends on home health nurse funding and availability. Home Healthcare 2007; 25(1) (in press). • Badger J. Factors that enable or complicate end of life transitions in critical care. Am J Crit Care 2005; 14(6): 513–521. | PubMed | • Stutts A, Schloemann J. Life sustaining support: ethical, cultural and spiritual conflicts. Neonat Network 2002; 21(4): 27–34. • Beckstrand R, Callister LC, Kirchhoff KT. Providing a 'good death': critical care nurses' suggestions for improving end of life care. Am J Crit Care 2006; 15(1): 38–45. | PubMed |

  25. Elpern E, Covert B, Kleinpell R. Moral distress in staff nurses in a medical intensive care unit. Am J Crit Care 2005; 14(6): 523–530. | PubMed | • Hefferman P, Heilig S. Giving 'moral distress' a voice: ethical concerns among neonatal intensive care unit personnel. Cambrid Quart Healthcare Ethic 1999; 8(2): 173–178. | Article | • Muraskas JMP, Tomich P, Myers TF, Gianopoulos JG, Thomasma DC. Neonatal viability in the 1990's: held hostage by technology. Cambrid Quart Healthcare Ethic 1999; 8(2): 160–170. | Article | • Solomon M, Sellers DE, Heller KS, Dokken DL, Levetown M, Rushton C et al. New and lingering controversies in pediatric end of life care. Pediatrics 2005; 116(4): 872–883. | Article | PubMed | • Catlin AJ, Carter BS. Creation of a neonatal end of life palliative care protocol. J Perinatol 2002; 22(3): 184–195. | Article | PubMed | • Glick C. Resuscitation of infants born at the limit of viability. J Perinatol 2005; 25(10): 623. | Article | PubMed | • Glicken AD, Merenstein GB. A neonatal end-of-life palliative protocol – an evolving new standard of care? Neonat Network 2002; 21(4): 35–36. • Hartline J. Always caring, especially when cure is not possible – an essential tenet of neonatal care. J Perinatol 2002; 22(3): 183. | Article | PubMed | • Gale G, Brooks A. Implementing a palliative care program in a newborn intensive care unit. Advan Neonat Care 2006; 6(1): 37–53. | Article | • Leuthner S, Pierruchi R. Experience with neonatal palliative care consultation at the Medical College of Wisconsin-Children's Hospital of Wisconsin. J Palliative Med 2001; 4(1): 39–47. | Article | • Rushton C. The other side of caring: caregiver suffering In: Carter and Levetown (eds). Palliative Care for Infants, Children and Adolescents. Johns Hopkins: Baltimore, 2004; 220–243. • Catlin AJ. Conscientious objection: a potential nursing response to care which causes suffering at the end of life. A Descriptive Pilot Study. 2007 (in review). • Berger J. Advance directives, due process, and medical futility. Ann Int Med 2004; 140(5): 402–403. | PubMed | • Clark P. Building a policy in pediatrics for medical futility. Pediatr Nurs 2001; 27(2): 180–184. | PubMed |

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