Neonatal intensive care unit to home: the transition from parent and pediatrician perspectives, a prospective cohort study.
OBJECTIVE
To describe the experience of a low-income population during the transition from the neonatal intensive care unit (NICU) to home and to compare these experiences with pediatrician perspectives.


METHODS
A prospective cohort study in a Level III, 40-bed NICU at a county hospital in Northern California affiliated with seven outpatient pediatric clinics. We surveyed parents in English or Spanish at discharge (n=79) and two weeks after discharge (n=49), along with outpatient pediatricians (n=17). Parents assessed experiences with discharge and the frequency with which barriers were encountered after discharge. We compared parent experiences with pediatrician estimates on four of these barriers.


RESULTS
Spanish survey participants had more difficulty finding a NICU doctor (P=0.05) or nurse (P=0.001) to answer their questions. After discharge, 16% of families experienced significant challenges with two or more barriers. In contrast, the majority of pediatricians estimated that 50% or more families had significant challenges with all four barriers.


CONCLUSIONS
Communication difficulties were the most commonly reported barriers during the NICU stay and physicians overestimated the frequency that families experienced challenges after discharge. Parent input is important to create effective interventions aimed at improving care and limiting disparities.
1] Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA [2] Department of Pediatrics, Pediatric Residency Program, Lucile Packard Children's Hospital, Palo Alto, CA, USA.
E
E
Enlow
Division of General Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA.
S L
SL
Herbert
Stanford University, Stanford, CA, USA.
I J
IJ
Jovel
Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
S A
SA
Lorch
Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA.
C
C
Anderson
Division of General Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA.
L J
LJ
Chamberlain
D002140:California; D015331:Cohort Studies; D003266:Continuity of Patient Care; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D007224:Infant Care / Q000379:methods; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D008297:Male; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D010351:Patient Discharge; D010372:Pediatrics; D010820:Physicians / Q000523:psychology*; D011203:Poverty; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric