| Abstract | OBJECTIVE: To assess whether the provision of computerized physiologic trend data could improve outcome in newborn infants
requiring intensive care. DESIGN: Randomized, controlled trial, with subsidiary questionnaire studies. SETTING: Tertiary neonatal
intensive care unit with 12 intensive care cots. PATIENTS: All infants admitted between January 1991 and September 1993 who
were < or =32 wks gestation or >32 wks gestation, and ventilated for >4 hrs or asphyxiated. INTERVENTIONS: Randomization to
one of four groups for first 7 days of life: A) no display of trend data; B) continuous display of trend data; C1) alternating 24-hr
display of trend data, starting with display in first 24 hrs; and C2) alternating 24-hr display of trend data, starting with no display in
first 24 hrs. MEASUREMENTS AND MAIN RESULTS: The short-term effects of monitoring on patient outcome was judged by
volume of colloid given, number of blood gases taken, and by measurement taken from cranial Doppler ultrasound. Medium-term
measures included time ventilated, time given supplemental oxygen, death, time to death or discharge, and cranial ultrasound at
discharge. Long-term outcome was assessed by neurodevelopmental status at age 1 to 4 yrs of age. Staff and parent questionnaires
assessed their respective attitudes to the introduction of this technology. None of the patient outcome measures, short-, medium-, or
long-term, demonstrated any significant benefit from the provision of computerized physiologic trend monitoring. Staff questionnaires
demonstrated an acceptance of the system and an improved understanding of neonatal physiology as a result of computerized
physiologic trends. Parent questionnaires demonstrated increased anxiety caused by the system in 11% of parents, although only 1%
of parents continued to have concerns if the system were able to help their child. CONCLUSIONS: A randomized, controlled trial
was unable to demonstrate any benefit to patients resulting from the introduction of a computerized physiologic trend monitoring
system. Benefits of the system have been recognized, however, in subsidiary studies, staff education, and research studies. |