Updating ProgenyHealth’s Best Practices in NICU Care

Posted by Steven Richardson, MD, MS on Jan 14, 2020 1:34:29 PM

Updating-Best-Practices-NICU

ProgenyHealth is the only company in the United States whose sole focus is the management of the care and support of infants hospitalized in the neonatal intensive care unit, as well as during the important months after their discharge from the hospital.  We are privileged to work with over 1,400 NICUs across the US, with our board-certified neonatologists and pediatricians interacting and collaborating with the attending physicians and hospital-based teams to drive the best possible health outcome for each child.

While some variation in health care provision is to be expected due to differences in medical training, community practice patterns, fundamental issues such as resource availability, and so on, the work of experts in health care quality and quality improvement, from Donabedian to Wennberg and Berwick, advocates strongly for the elimination of unnecessary variation, whenever possible.  To that end, utilizing our national perspective on neonatal care delivery, ProgenyHealth publishes online best practices documents that summarize the consistent, evidence-based care that we feel helps to optimize NICU outcomes. The most current best practices documents and more educational content can be found in our Knowledge Center.

Our best practice documents are extensively researched and written by our staff physicians, then evaluated for accuracy and clinical applicability by our external physician committee members. All our practicing neonatologists are from various regions around the country, most of whom are affiliated with academic medical centers. We re-evaluate the documents annually to ensure that the information reflects the current medical literature and practice trends, with complete review and approval of the changes from our committee members before web publication.

Four of our best practices documents were recently updated:

Management Best Practice for Infants with Apnea and Bradycardia of Prematurity

Best Practices in the Management of Infants with Neonatal Abstinence Syndrome

Discharge Best Practice for NICU Patients

Thermoregulation Best Practice for Premature Infants  

In addition, a best practice document on feeding in the NICU, Feeding Best Practice for NICU Patients, was added.  An overview of the documents and updates made to each follows.

Infants with Apnea and Bradycardia of the Newborn

Large variability between NICUs exists in the management of apneic and bradycardic events as the infant approaches the discharge date. While many NICUs have specific protocols or criteria that specify such things as the definition of what constitutes an apneic event, what level and extent of bradycardia is clinically significant, what constitutes an intervention, and other parameters that might trigger the initiation of an apnea/bradycardia countdown or watch, we also find facilities where no such documents exist or, if present, the procedures are not consistently followed by NICU staff. 

This document is meant to provide some guidance, based on practice patterns that we’ve observed, as well as nationally recognized criteria, for those facilities that do not have written policies in place for management.  Updates in this version include de-emphasizing home apnea monitoring as community practices have changed, reinforcing the need for caregivers to receive CPR and first aid training prior to hospital discharge, and literature reference updates.

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Management of Infants with Neonatal Abstinence Syndrome

NAS is a major contributor to both NICU admissions and length of stay once admitted. Here, too, we have found that some facilities do not have internal documentation or a protocol for managing these cases. As a result, the approach that we’ve observed to the management of these admissions is often inconsistent. Our document is a distillation of the clinical literature and observations of successful NICU programs in their management of these infants.

Significant updates in this version include a modification to the recommendation for the morphine dosage at which discontinuation should be considered, as levels below this dose are unlikely to have clinical effectiveness, an expansion of the discussion of the ESC (Eat, Sleep, Console) protocol being used more frequently in NICUs, and updated references.

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Discharge Best Practice for NICU Patients

This document is a compilation of best practices from the literature and our clinicians as to the elements of planning that are important to ensure a seamless transition from the NICU to the home setting. 

Updates include reference revisions, modification of the emphasis on home apnea monitoring, and additional encouragement for utilizing the entire care team in promoting safe discharges.

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Thermoregulation Best Practice for Premature Infants

The ability of the newborn to maintain adequate body temperature is one of the pillars of discharge readiness that needs to be demonstrated for safe transition of the infant to the home setting.  This best practice document provides an overview of optimized, literature-supported approaches to managing the thermoregulation needs of a NICU infant to discharge.

Updates to references and terminology were the primary changes for this new version.

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Feeding Best Practice for NICU Patients

Our newest best practice document arose from a recognition that, like the management of apnea/bradycardia and NAS, there is often a lack of specific protocols in some facilities for the management of feeding progression. Delays in advancement in feedings are often the cause of unnecessarily prolonged lengths of stay, as well as having the potential for significant adverse effects on the newborn’s health. 

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We encourage sharing of our best practices documents to help support our clinical colleagues on the front lines of care as we pursue our common goal of ensuring all NICU infants have every opportunity to achieve a healthy outcome. Be sure to subscribe to our NICU Insights Blog to receive our latest articles and educational content. 

Steven Richardson, MD, MS, is Chief Medical Officer at ProgenyHealth.

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Topics: neonatal abstinence syndrome, NICU best practices