Children who 'grow up' in hospital: Inpatient stays of six months or longer.

Over the past several decades, the number of children receiving mechanical ventilation and the number of paediatric intensive care unit (PICU) beds has dramatically increased in developed countries. A recent study conducted in the United States showed that the incidence of mechanical ventilation in hospitalized children almost doubled between 1991 and 2001, from 77 per 1000 hospitalizations in 1991 to 124 per 1000 in 2001 (1). Simultaneously, novel life-sustaining therapies have come into mainstream clinical use, including extracorporeal membrane oxygenation (ECMO), ventricular assist devices (VADs), and increasingly complex solid organ transplantations such as neonatal cardiac transplants and multivisceral transplants for short bowel syndrome. Children with chronic complex conditions account for a steadily increasing proportion of hospitalized paediatric patients and health care resource consumption (2). Two decades ago, a long hospitalization of a child was considered to be >1 week (3). Currently, long hospitalizations are counted in months and even years. Increasing length of stay and acuity of stay has been well documented at the Stollery Children’s Hospital in Edmonton, Alberta, in the neonatal intensive care unit (NICU), PICU and wards (internal documents), which is similar to the trends of other tertiary/quaternary paediatric hospitals (4). Despite this, very little research has been published about these patients and their families. One study involving infants who were hospitalized from the neonatal period for ≥6 months revealed a primary theme of “doing the wrong thing” on the part of health care professionals who cared for these infants. Another important finding was that 23% of these infants no longer had ongoing contact with their parents, who had been overwhelmed by the demands of their medical care (5). The purpose of the present study was to describe the population of children who experienced a very long hospital stay. Although beyond the scope of the present study, better understanding this patient population is important because of the inevitable impact long hospitalization has on children, their families and health care resource utilization.