Thanks to the managed care industry, in our area the targeted length of
stay for the infant with RSV pneumonia, as outlined in the care map is 4
days.  Any infant that can not be discharged in that length of time is
said to be complicated and an "outlier."

To translate that into consumer friendly language:

"Targeted length of stay" is the "benchmark" or average length of time
an infant with RSV requires in hospital skilled nursing care.  This
number is determined in a number of different ways.  Our local hospital
with the peds ICU determined its own benchmark by reviewing previous
experience in the recent past.

"Care map" is a combination of medical orders and nursing care plan laid
out on a day by day grid showing how it is expected that a "typical"
case will proceed.  It includes such things as lab tests and expected
results, use of oxygen to maintain blood levels that are acceptable,
what the acceptable blood levels of oxygen is, use of IV fluids,
antibiotics, etc.

Being an "outlier" means that the patient's care is costing more than
managed care may be willing to pay, and thus means that the hospital may
be in danger of loosing money on the care of that patient.  This is more
of a problem with the elderly than it is with young children, as
Medicare has a fixed amount that is paid for a given diagnosis, and most
insurance plans still pay a negotiated percentage of the cost of care
for younger patients.

With these new "care maps" I have seen many more infants discharged home
on oxygen who might have stayed in the hospital for a longer period four
or five years ago.

It is true that younger infants are much more likely to require more
intensive care and many of them actually require two or three days on
respirator support when they contract RSV.  So I think you are still
justified in your belief that the breastfeeding helped to protect them.
Our hospital simply has not tracked neonatal RSV versus other age
groups.  The target population for the RSV care map is any infant
through 18 month old.

Melinda Hoskins, MS, RN LC-wanna-be
Northern Nevada, USA,  "where we are always gambling on something, I
just wish it wasn't the baby's health so often."