Comparison of neonatal nurse practitioners' and pediatric residents' care of extremely low-birth-weight infants

Objective: To compare outcomes and charges of health care delivery to extre mely low-birth-weight infants by neonatal nurse practitioners (NNP) and ped iatric residents. Design: Retrospective cohort study. Setting: A 56-bed neonatal intensive care unit (NICU) in a university teach ing 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 Sept ember 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 malformation s, 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 in fants. Main Outcome Measures: Survival, length of stay, and total charges. Results: Survival to discharge occurred for 71 NNP team infants (76%) and 8 2 resident team infants (77%) (P=.87). The median total length of stay was 87 days (range, 39-230 days) for NNP ream infants and 88 days (range, 41-36 5 days) for resident team infants (P=.54). There were no significant differ ences between NNP infants and resident team infants in the prevalence of se vere intracranial hemorrhage, threshold retinopathy of prematurity, or chro nic lung disease at 36 weeks postconceptual age. Median total NICU hospital charges were $141624 (range, $52020-$693018) for NNP team infants and $139 388 (range, $50178-$990865) for resident team infants (P=.89). There were n o significant differences between NNP team infants and resident team infant s in NICU charges for laboratory, radiology, or pharmacy services. Conclusion: Neonatal nurse practitioners and pediatric residents provided c omparable patient care to extremely low-birth-weight infants, with similar outcomes and similar charges.