Abstract
Objective NICU graduates are frequently technology dependent including home oxygen, pulse oximetry,
and/or nasogastric (NG) feedings. Primary care provider (PCP) perceptions, practices,
and barriers to managing these infants are not well described, especially at altitude.
We sought to 1) describe PCP comfort and 2) determine practices and barriers in managing
this technology at higher altitudes.
Study Design This cross-sectional survey assessed Colorado and Wyoming PCP perceptions and practices
surrounding technology in NICU graduates. We explored bivariate analysis between clinic
altitude, location, and provider's experience with comfort caring for infants discharged
with technology using chi-squared or Fisher's exact tests. Significant relationships
were modeled using logistic regression for odds ratios and 95% confidence intervals.
Results Among 203 respondents, 82% were pediatricians, and 86% practiced in urban/suburban
environments. Clinic altitude ranged 2,500–9,000 ft. PCPs endorsed comfort managing
oxygen in term (92%) and moderately/late preterm infants (82%), versus 52% comfort
in very/extremely preterm infants. 62% utilized an oxygen-weaning algorithm. Comfort
managing oxygen was greater in suburban versus urban locations (odds ratio [OR] = 4.4,
95% confidence interval [CI]: 1.6–11.7) and providers practicing for >10 versus <5
years (OR = 3.5, 95% CI: 1.5, 8.4). 60% found pulse oximetry useful, though 70% perceived
caregiver stress. 69% accepted infants on NG feeds, though 61% endorsed discomfort
with management.
Conclusion PCPs are comfortable managing home oxygen in moderately preterm to term infants but
find caring for most preterm infants challenging. Discomfort in managing NG feeds
is prevalent. This highlights peridischarge barriers and improvement opportunities
for high-risk, technology-dependent infants.
Key Points
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PCPs are uncomfortable managing very/extremely preterm infants on home oxygen after
NICU discharge.
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PCPs perceive frequent commercial pulse oximetry use in NICU graduates.
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Most PCPs are uncomfortable managing home NG feedings.
Keywords
neonatology - NICU discharge - home oxygen therapy - feeding difficulties - home pulse
oximetry
