RELATIONAL DATABASE USE IN ONE NEONATAL INTENSIVE CARE UNIT AND A PROPOSAL FOR A VOLUNTARY, NATIONAL COLLABORATIVE OUTCOME AND NEONATAL MEDICAL INTERVENTION REPORTING SYSTEM USING THE INTERNET. 1606

Recently, most tertiary neonatal intensive care units (NICUs) in the U.S. are using or are planning a computerized database for statistical reporting, quality assurance, and research activities¹. However, large collaborative research networks, such as the Vermont-Oxford Trials Network² which have demonstrated wide variation in neonatal care and outcome among hospitals in a single region, are rare. The Internet, with its ability to transfer data securely and virtually instantaneously, and relational database tools, such as FoxPro, which link related database tables via a common field, provide a unique, historic opportunity in neonatology to create a national database on infants cared for in NICUs in the U.S. We present a database program created using FoxPro which could serve as a model for such a system. Over 600 data items are collected on all patients admitted to our NICU using a cross-platformed, networked system. Neonatal fellows begin entering patient data into the database at the time of admission, which is completed at discharge. The data is reviewed by attendings; as well, many built-in error codes prevent the entry of implausible or inconsistent data. The program generates all attending/fellow admission notes and discharge summaries, letters to referring/follow-up physicians or to accompany families at patient discharge, and monthly statistical reports. Our system exceeds all of the features likely to provide database satisfaction¹, and is malleable to future needs within our hospital and for research projects. This database program could also be modified to meet the needs of other neonatal units. Portions of local databases could then be donated via the Internet to a central national server using current FTP protocols and security procedures, and related to the other local databases. The consortium of contributing centers could use this central database for epidemiological research and for direct comparison regarding outcome, differences in neonatal practice, and quality control. Such a consortium could quickly be created producing a nation-wide database at low cost, which could contribute to further improvement in neonatal care and establish a nation-wide standard of care in neonatal practice which at the present time does not exist.