Comparison of neonatal nurse practitioners' and pediatric residents' care of extremely low-birth-weight infants.
OBJECTIVE
To compare outcomes and charges of health care delivery to extremely low-birth-weight infants by neonatal nurse practitioners (NNP) and pediatric residents.


METHODS
Retrospective cohort study.


METHODS
A 56-bed neonatal intensive care unit (NICU) in a university teaching hospital.


METHODS
Study population included all infants with birth weights less than 1000 g who were admitted to the NICU during the 2-year period between September 1, 1994, and August 31, 1996. Infants who died earlier than 12 hours of age, or who were admitted after 1 week of age or with major malformations, chromosomal abnormalities, or congenital infections were excluded. There were separate teams of NNPs and residents providing care around the clock. The study group included 201 infants with birth weights of less than 1000 g. The NNP team cared for 94 infants and the resident team cared for 107 infants.


METHODS
Survival, length of stay, and total charges.


RESULTS
Survival to discharge occurred for 71 NNP team infants (76%) and 82 resident team infants (77%) (P =.87). The median total length of stay was 87 days (range, 39-230 days) for NNP team infants and 88 days (range, 41-365 days) for resident team infants (P =.54). There were no significant differences between NNP infants and resident team infants in the prevalence of severe intracranial hemorrhage, threshold retinopathy of prematurity, or chronic lung disease at 36 weeks postconceptual age. Median total NICU hospital charges were $141,624 (range, $52,020-$693,018) for NNP team infants and $139,388 (range, $50,178-$990,865) for resident team infants (P =.89). There were no significant differences between NNP team infants and resident team infants in NICU charges for laboratory, radiology, or pharmacy services.


CONCLUSIONS
Neonatal nurse practitioners and pediatric residents provided comparable patient care to extremely low-birth-weight infants, with similar outcomes and similar charges.
Karlowicz
M G
MG
Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA 23207, USA. gkarlowi@chkd.com
McMurray
J L
JL
D002543:Cerebral Hemorrhage / Q000401:mortality / Q000534:rehabilitation; D002662:Child Health Services / Q000592:standards; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007396:Internship and Residency; D007902:Length of Stay / Q000706:statistics & numerical data; D007969:Leukomalacia, Periventricular / Q000401:mortality / Q000534:rehabilitation; D008171:Lung Diseases / Q000401:mortality / Q000534:rehabilitation; D008297:Male; D009722:Nurse Practitioners; D010372:Pediatrics / Q000193:education*; D012178:Retinopathy of Prematurity / Q000401:mortality / Q000534:rehabilitation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D000078329:Workforce