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Am J Perinatol 2024; 41(S 01): e494-e500
DOI: 10.1055/a-1905-5245
Original Article

Trends in Procedures in the Neonatal Intensive Care Unit

Ibrahim Sammour
1   Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
,
Sreenivas Karnati
1   Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
,
Hasan Othman
2   Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, Michigan
,
Farah Heis
1   Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
,
Allison Peluso
1   Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
,
Hany Aly 
1   Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
› Author Affiliations
Funding None.
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Abstract

Objective The aim of the study is to identify the rates and trends of various procedures performed on newborns.

Study Design The Healthcare Cost and Utilization Project (HCUP) database for the years 2002 to 2015 was queried for the number of livebirths, and various procedures using International Classification of Diseases, Ninth Revision (ICD-9) codes. These were adjusted to the rate of livebirths in each particular year. A hypothetical high-volume hospital based on data from the last 5 years was used to estimate the frequency of each procedure.

Results Over the study period, there was a decline in the rates of exchange transfusions and placement of arterial catheters. There was an increase in the rates of thoracentesis, abdominal paracentesis, placement of umbilical venous catheter (UVC) lines, and central lines with ultrasound or fluoroscopic guidance. No change was observed in the rates of unguided central lines, pericardiocentesis, bladder aspiration, intubations, and LP. Intubations were the most performed procedures. Placement of UVC, central venous lines (including PICCs), arterial catheters, and LP were relatively common, whereas others were rare such as pericardiocentesis and paracentesis.

Conclusion Some potentially lifesaving procedures are extremely rare or decreasing in incidence. There has also been an increase in utilization of fluoroscopic/ultrasound guidance for the placement of central venous catheters.

Key Points

  • Advances in neonatal care have impacted the number of procedures performed in the NICU.

  • It is unclear whether invasive procedures occur at rates sufficient for adequate training and maintenance of skills.

  • Understanding the NICU procedural trends is important in designing simulation and competency-based medical education programs.

Keywords

pericardiocentesis - paracentesis - thoracentesis - exchange transfusion - lumbar puncture - bladder aspiration - arterial catheterization - umbilical catheter

Authors' Contributions

I.S. and S.K. conceptualized and designed the study, performed the initial analysis, drafted the initial manuscript, and reviewed and revised the manuscript and contributed equally. H.O. and F.H. designed the data collection instrument, collected the data, and reviewed and revised the manuscript. A.P. and H.A. conceptualized and designed the study, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.




Publication History

Received: 24 January 2022

Accepted: 12 July 2022

Accepted Manuscript online:
20 July 2022

Article published online:
23 September 2022

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