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Published on: January 12, 2018
Resource and Service Use after Discharge Among Infants 22-25 Weeks Estimated Gestational Age at the First High-Risk
Vidya V Pai1, Tianyao Lu2, Erika E Gray2
1Division of Neonatology, UCSF Benioff Children's Hospital Oakland, Oakland, CA.
Insights
Infants born extremely preterm utilize significant healthcare resources post-discharge. Resource use is linked to maternal factors and clinical conditions, highlighting the need for early support and referrals for these vulnerable infants.
Area of Science:
- Neonatalogy
- Pediatric Healthcare Services
- Public Health
Background:
- Infants born extraordinarily preterm (22-25 weeks gestation) require extensive medical care.
- High-risk infant follow-up (HRIF) programs aim to manage complex needs post-discharge.
- Understanding resource utilization is crucial for optimizing care coordination.
Purpose of the Study:
- To analyze resource and service utilization in extremely preterm infants.
- To identify factors associated with high service use in this population.
- To inform care strategies for infants discharged from neonatal intensive care units (NICUs).
Main Methods:
- Retrospective analysis of California Perinatal Quality Care Collaborative and California Children's Services HRIF databases (2010-2017).
- Inclusion of infants born between 22 and 25 weeks' gestational age.
- Evaluation of hospitalization, surgeries, medications, equipment, medical, and special services, and referrals.
Main Results:
- Of 5284 infants, 3941 attended HRIF by 12 months corrected age.
- Earlier gestational age correlated with increased use of medications, equipment, medical, and special services.
- Maternal education, major morbidity, surgery, and caregiver concerns were associated with higher odds of receiving multiple services.
Conclusions:
- Extremely preterm infants exhibit substantial post-discharge resource and service utilization.
- Resource use is influenced by maternal sociodemographic factors and clinical characteristics.
- Early identification of service needs and parental guidance are essential for optimal outcomes.
Objective:
To examine resource and service use after discharge among infants born extraordinarily preterm in California who attended high-risk infant follow-up (HRIF) clinic by 12 months corrected age.
Study Design:
We included infants born 2010-2017 between 22 + 0/7 and 25 + 6/7 weeks' gestational age in the California Perinatal Quality Care Collaborative and California Perinatal Quality Care Collaborative-California Children's Services HRIF databases. We evaluated rates of hospitalization, surgeries, medications, equipment, medical service and special service use, and referrals. We examined factors associated with receiving ≥ 2 medical services, and ≥ 1 special service.
Results:
A total of 3941 of 5284 infants received a HRIF visit by 12 months corrected age. Infants born at earlier gestational ages used more medications, equipment, medical services, and special services and had higher rates of referral to medical and special services at the first HRIF visit. Infants with major morbidity, surgery, caregiver concerns, and mothers with more years of education had higher odds of receiving ≥ 2 medical services. Infants with Black maternal race, younger maternal age, female sex, and discharge from lower level neonatal intensive care units (NICUs) had lower odds of receiving ≥ 2 medical services. Infants with more educated mothers, multiple gestation, major morbidity, surgery, caregiver concerns, and discharge from lower level NICUs had increased odds of receiving a special service.
Conclusions:
Infants born extraordinarily preterm have substantial resource use after discharge. High resource utilization was associated with maternal/sociodemographic factors and expected clinical factors. Early functional and service use information is valuable to parents and underscores the need for NICU providers to appropriately prepare and refer families.
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