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M. Gary Karlowicz, MD; Jennifer L. McMurray, RN, MSN, CNNP, CPNP

Arch Pediatr Adolesc Med. 2000;154:1123-1126.

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

Design  Retrospective cohort study.

Setting  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.

Main Outcome Measures  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.

Conclusion  Neonatal nurse practitioners and pediatric residents provided comparable patient care to extremely low-birth-weight infants, with similar outcomes and similar charges.

From the Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters (Dr Karlowicz) and the School of Nursing, College of Health Science, Old Dominion University (Ms McMurray); Norfolk, Va.

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