Novel Program to ‘CATCH’ a NICU Graduate’s Problems Early

John Chuo, MD, MS

The literature reports that one-third of 600 000 children in the United States who are dependent on medical technology are NICU graduates. In addition, as high as 50% of preterm NICU graduates are reported to be seen in the emergency room within 3 months of discharge, and 30% are readmitted to the hospital. The highest risk for these infants is within the first 2 weeks after discharge. Each year at Children’s Hospital of Philadelphia, more than 300 medically complex neonates go home with tube feeds and other technological equipment, including oxygen and monitors, and make their journey through this vulnerable period.

The CHOP Neonatal CATCH Program is a specialized team of Newborn/Infant Intensive Care Unit providers using remote patient management technology to help families and their community primary care providers manage the multitude of medical and surgical issues during the first 30 days post discharge.

The program 1) reinforces education caregivers received from the hospital, 2) monitors the baby’s weight and growth, and 3) communicates with their primary healthcare providers and subspecialists to adjust care plans and facilitate overall situational awareness and intercommunication. Through this integrated multi/interdisciplinary care approach, we hope to promote optimal health outcomes and avoid preventable readmissions and emergency room emergency room visits.

After discharge, the program schedules a telemedicine visit with the baby’s designated caregiver within the first week the baby is home and sends them at least 7 text message communications over 4 weeks. The messaging system asks parents to enter growth data, enables them to watch education videos, notify the CATCH team with questions, and request a call from the team.

CATCH messages and alerts are monitored by the CATCH team Monday thru Friday. For emergencies, the parents are instructed to either call their primary care provider or go to the emergency room. The CATCH team acknowledges the primary role and experience of the baby’s care provider and will always discuss any care plan recommendations with them. In addition, the CATCH team will contact appropriate subspecialists when needed.

Here is one case study of how the CATCH Program worked:

The CATCH team discovered rapidly progressing hydrocephalus in an otherwise well NICU graduate. The team called the patient’s primary care pediatrician in her office and concurred with our findings. The patient was admitted to CHOP for shunt placement and was discharged home 3 days later.