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Published on: November 20, 2015
Paediatric intensive care admissions of preterm children born <32 weeks gestation: a national retrospective cohort
Tim J van Hasselt1, Chris Gale2, Cheryl Battersby2
1Department of Population Health Sciences, University of Leicester, Leicester, UK t.vanhasselt@nhs.net.
Insights
Most very preterm babies (<32 weeks) discharged home do not need paediatric intensive care unit (PICU) admission. However, the risk of unplanned PICU admission increases with lower gestation and significant neonatal morbidities.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Public Health
Background:
- Survival rates for very preterm infants (<32 weeks gestational age) have improved.
- Preterm-born children may experience ongoing health issues (morbidity).
Purpose of the Study:
- To assess the risk of paediatric intensive care unit (PICU) admission for very preterm infants after neonatal discharge.
- To identify factors associated with PICU readmission in this population.
Main Methods:
- Retrospective cohort study utilizing linked national datasets (National Neonatal Research Database and Paediatric Intensive Care Audit Network).
- Inclusion of all children born very preterm (2013-2018) admitted to neonatal units in England and Wales.
- Primary outcome: PICU admission before two years of age after discharge home.
Main Results:
- 5.7% (2308/40690) of very preterm infants experienced at least one PICU admission post-discharge.
- 1901 of these admissions were unplanned.
- Factors associated with unplanned PICU admission included lower gestation, male sex, bronchopulmonary dysplasia, necrotising enterocolitis requiring surgery, and brain injury.
Conclusions:
- The majority of very preterm infants discharged from neonatal care do not require PICU admission within the first two years.
- Higher risk of unplanned PICU admission is linked to extreme prematurity and severe neonatal morbidities.
Objective:
Survival of babies born very preterm (<32 weeks gestational age) has increased, although preterm-born children may have ongoing morbidity. We aimed to investigate the risk of admission to paediatric intensive care units (PICUs) of children born very preterm following discharge home from neonatal care.
Design:
Retrospective cohort study, using data linkage of National Neonatal Research Database and the Paediatric Intensive Care Audit Network datasets.
Setting:
All neonatal units and PICUs in England and Wales.
Patients:
Children born very preterm between 1 January 2013 and 31 December 2018 and admitted to neonatal units.
Main Outcome Measures:
Admission to PICU after discharge home from neonatal care, before 2 years of age.
Results:
Of the 40 690 children discharged home from neonatal care, there were 2308 children (5.7%) with at least one admission to PICU after discharge. Of these children, there were 1901 whose first PICU admission after discharge was unplanned.The percentage of children with unplanned PICU admission varied by gestation, from 10.2% of children born <24 weeks to 3.3% born at 31 weeks.Following adjustment, unplanned PICU admission was associated with lower gestation, male sex (adjusted OR (aOR) 0.79), bronchopulmonary dysplasia (aOR 1.37), necrotising enterocolitis requiring surgery (aOR 1.39) and brain injury (aOR 1.42). For each week of increased gestation, the aOR was 0.90.
Conclusions:
Most babies born <32 weeks and discharged home from neonatal care do not require PICU admission in the first 2 years. The odds of unplanned admissions to PICU were greater in the most preterm and those with significant neonatal morbidity.
