Copyright © 2019 National Association of Neonatal Nurses. Unauthorized reproduction of this article is prohibited. 275 Advances in Neonatal Care • Vol. 19, No. 4 • pp. 275–284 Outcomes of Neonatal Care ❍ Section Editor Paula L. Forsythe, MSN, RN, CNS B ecause of advances in medical technology and innovative treatments, the numbers of children with complex medical needs (CMN) are increasing exponentially. 1 These children, by defini- tion, have complex chronic conditions requiring specialized care, substantial healthcare needs, func- tional limitations, high use of health resources, and hospitalizations. 2-4 A significant proportion of chil- dren with CMN have been patients in the neonatal intensive care unit (NICU) and develop chronic dis- eases that affect physical health, development, growth, and educational achievement. 5,6 Similar to older children, neonates with multiple medical prob- lems may benefit from care by specialized multidisci- plinary teams. 7-12 Outcomes of neonates with CMN who have received care primarily by a specialized neonatal complex care coordination team have not been reported. Such an evaluation would identify areas for improving the care of neonates with CMN. The primary aim of this study was to describe the clinical profile, resource use, prevalence, and both in- hospital and postdischarge outcomes of neonates with CMN. The secondary aim was to assess the fea- sibility of sustaining the use of the neonatal complex care team (NCCT). METHODS A retrospective cohort study was conducted on inborn and outborn neonates with CMN, born Outcomes of Neonates With Complex Medical Needs Emily Kieran, MD, PhD; Rahnuma Sara, BSc; Jennifer Claydon, MSc; Valoria Hait, MSc; Julie de Salaberry, MSc; Horacio Osiovich, MD; Sandesh Shivananda, MD, MSc, FRCPC ABSTRACT Background: Children with complex medical needs (CMN) are high healthcare resource utilizers, have varying underly- ing diagnoses, and experience repeated hospitalizations. Outcomes on neonatal intensive care (NICU) patients with CMN are unknown. Purpose: The primary aim is to describe the clinical profile, resource use, prevalence, and both in-hospital and postdis- charge outcomes of neonates with CMN. The secondary aim is to assess the feasibility of sustaining the use of the neonatal complex care team (NCCT). Methods: A retrospective cohort study was conducted after implementing a new model of care for neonates with CMN in the NICU. All neonates born between January 2013 and December 2016 and who met the criteria for CMN and were cared for by the NCCT were included. Results: One hundred forty-seven neonates with a mean (standard deviation) gestational age of 34 (5) weeks were included. The major underlying diagnoses were genetic/chromosomal abnormalities (48%), extreme prematurity (26%), neurological abnormality (12%), and congenital anomalies (11%). Interventions received included mechanical ventilation (69%), parenteral nutrition (68%), and technology dependency at discharge (91%). Mortality was 3% before discharge and 17% after discharge. Postdischarge hospital attendances included emergency department visits (44%) and inpatient admissions (58%), which involved pediatric intensive care unit admissions (26%). Implications for Practice: Neonates with CMN have multiple comorbidities, high resource needs, significant postdis- charge mortality, and rehospitalization rates. These cohorts of NICU patients can be identified early during their NICU course and serve as targets for implementing innovative care models to meet their unique needs. Implications for Research: Future studies should explore the feasibility of implementing innovative care models and their potential impact on patient outcomes and cost-effectiveness. Key Words: complex medical needs, neonatal intensive care, neonates, nursing, outcomes Author Affiliations: Division of Neonatology, BC Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada (Drs Kieran, Osiovich, and Shivananda and Mss Claydon, Hait, and de Salaberry); and Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada (Drs Kieran, Osiovich, and Shivananda and Mss Sara and Claydon). The authors thank Marissa Gibbard for review of the manuscript. The authors thank all past and present members of neonatal complex care teams for their commitment, dedication, and untiring efforts to improve the care of neonates with complex medical needs. The authors thank all BCWH NICU neonatolo- gists, house staff, allied staff, and point-of-care providers, senior executives as well as BC Children’s Hospital subspecialists for encouragement and sup- port while implementing the complex care team model. All authors have no conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.advancesinneonatalcare.org). Correspondence: Sandesh Shivananda, MD, MSc, FRCPC, Division of Neonatology, BC Women’s Hospital and Health Centre, 4500 Oak St, Room No. 1R-19, Vancouver, BC V6H 3V4, Canada (sandesh. shivananda@cw.bc.ca). Copyright © 2019 by The National Association of Neonatal Nurses DOI: 10.1097/ANC.0000000000000639