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Intrafacility Neonatal Intensive Care Unit to Pediatric Intensive Care Unit Transfer in the United States: A
Phillip D Cohen1, Michelle M Gontasz2, Meghan Bernier1
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Objective:
To describe and trend the frequency of intrafacility neonatal intensive care unit (NICU) to pediatric intensive care unit (PICU) transfers among the US children's hospitals and evaluate potential relationships between patient characteristics, transfer timing, and post-transfer outcomes.
Study Design:
We conducted a multicenter retrospective cohort study from 2016 to 2022 of children undergoing intrafacility NICU to PICU transfers using diagnosis and procedure codes from the Pediatric Health Information Systems database. Primary study outcomes were as follows: (1) intrafacility transfer rate, (2) patient age at transfer, and (3) post-transfer length of stay (LOS). Clinical features were assessed for association with transfer age and post-transfer LOS.
Results:
A total of 4.98% of NICU encounters underwent PICU transfer. Rates did not increase significantly over time (annual range 4.21%-5.40%) with a bimodal distribution peaking among those <10 (41.2%) and >100 days (20.5%) old. Those transferred at an older chronological age (ie, fifth quintile-median of 183 days [IQR: 135-271]) more frequently had tracheostomy (40.2% vs 2.5%) and history of cardiopulmonary resuscitation (7.8% vs 3.9%), and less frequently experienced extracorporeal life support (16.8% vs 3.4%) and parenteral nutrition (76.5% vs 60.8%) than a younger age (ie, first quintile-median age 1 day [IQR: 0-1]) (all P < .001). Clinical features of technology dependence and severe morbidity were associated with a longer post-transfer LOS.
Conclusions:
Annual intrafacility NICU to PICU transfer rates ranged between 4.21% and 5.4% occurring most frequently among neonates aged <10 and >100 days. Post-transfer LOS and timing of transfer were associated with markers of medical complexity, emphasizing the importance of optimizing multidisciplinary handover and minimizing transfer-related morbidity.
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