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Intensive care unit readmission during childhood after preterm birth with respiratory failure
Peter M Mourani1, John P Kinsella1, Gilles Clermont2
1Pediatric Heart Lung Center, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO.
Insights
Preterm infants needing mechanical ventilation at birth face high risks of intensive care unit readmission and prolonged healthcare needs. These infants incur significant treatment costs, highlighting the need for ongoing support and resource allocation.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Health Services Research
Background:
- Preterm infants requiring mechanical ventilation at birth are a vulnerable population.
- Understanding readmission risks is crucial for optimizing care and resource allocation.
- Previous studies have not fully elucidated long-term readmission patterns and associated costs.
Purpose of the Study:
- To determine the incidence and risk factors for intensive care unit (ICU) readmission in preterm infants who received mechanical ventilation at birth.
- To identify predictors of ICU readmission and additional mechanical ventilation needs.
- To assess the healthcare costs associated with ICU readmissions.
Main Methods:
- A multicenter cohort study of preterm newborns (birth weight 500-1250 g) requiring mechanical ventilation at birth.
- Follow-up assessments up to 4.5 years, including in-person evaluations and telephone interviews.
- Univariate and multivariable analyses of baseline and birth hospitalization data to identify predictors of ICU readmission.
Main Results:
- 19% of infants were readmitted to the ICU, and 12% required additional mechanical ventilation.
- Risk factors for ICU readmission included male sex, severe intracranial hemorrhage, longer birth hospitalization, and prolonged oxygen therapy.
- ICU readmission in the first year was associated with significantly higher healthcare costs.
Conclusions:
- Mechanically ventilated preterm infants face a substantial risk of ICU readmission and late mechanical ventilation.
- These infants utilize extensive healthcare resources and incur high treatment costs.
- Findings underscore the need for comprehensive, long-term management strategies and resource planning for this population.
Objective:
To determine the incidence and risk factors for readmission to the intensive care unit (ICU) among preterm infants who required mechanical ventilation at birth.
Study Design:
We studied preterm newborns (birth weight 500-1250 g) who required mechanical ventilation at birth and were enrolled in a multicenter trial of inhaled nitric oxide therapy. Patients were assessed up to 4.5 years of age via annual in-person evaluations and structured telephone interviews. Univariate and multivariable analyses of baseline and birth hospitalization predictors of ICU readmission were performed.
Results:
Of 512 subjects providing follow-up data, 58% were readmitted to the hospital (51% of these had multiple readmissions, averaging 3.9 readmissions per subject), 19% were readmitted to an ICU, and 12% required additional mechanical ventilation support. In univariate analyses, ICU readmission was more common among male subjects (OR 2.01; 95% CI 1.27-3.18), infants with grade 3-4 intracranial hemorrhage (OR 2.13; 95% CI 1.23-3.69), increasing duration of birth hospitalization (OR 1.01 per day; 95% CI 1.00-1.02), and prolonged oxygen therapy (OR 1.01 per day; 95% CI 1.00-1.01). In the first year after birth hospitalization, children readmitted to an ICU incurred greater health care costs (median $69,700 vs $30,200 for subjects admitted to the ward and $9600 for subjects never admitted).
Conclusions:
Small preterm infants who were mechanically ventilated at birth have substantial risk for readmission to an ICU and late mechanical ventilation, require extensive health care resources, and incur high treatment costs.
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