Risk for pediatric intensive care utilization in children born before 30 weeks of gestation: a single-center study
Annemijn C C B Ekelmans1,2,3,4, Rosemarie de Ridder1,4, Suzanne W J Terheggen2,4
1Neonatal Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Approximately 10% of infants born before 30 weeks gestation require pediatric intensive care unit (PICU) admission after neonatal intensive care unit (NICU) discharge. Extreme prematurity and necrotizing enterocolitis increase this risk.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Public Health
Background:
- Increased survival rates for preterm infants.
- Preterm infants face higher morbidity and healthcare utilization post-neonatal intensive care unit (NICU) discharge.
Purpose of the Study:
- Determine the rate of pediatric intensive care unit (PICU) admission in infants born before 30 weeks gestational age (GA) after NICU discharge.
- Identify risk factors for PICU admission in this vulnerable population.
Main Methods:
- Retrospective, single-center study.
- Included 459 infants born between 2016-2021 with GA < 30 weeks.
- Follow-up period of 3-9 years post-NICU discharge.
Main Results:
- 10.9% of infants were admitted to the PICU at least once.
- PICU admission rates varied by GA (23.5% at 24 weeks vs. 6.5% at 29 weeks).
- Gestational age < 28 weeks (OR 2.41) and necrotizing enterocolitis grade ≥ 2 (OR 6.20) were independent risk factors for PICU admission.
Conclusions:
- One in ten infants born before 30 weeks gestation required PICU admission after NICU discharge.
- Extreme prematurity and necrotizing enterocolitis are significant risk factors for subsequent PICU admission.
Abstract:
Extremely preterm-born infants face critical complications after birth that may necessitate health care utilization later in life, including rehospitalization with admission to the pediatric intensive care unit (PICU). However, their specific risk for PICU readmission after discharge from the neonatal intensive care unit (NICU) is currently unclear. Further knowledge on this topic may aid critical care resource planning and parent counseling. In this study, we aimed to determine the rate of PICU admission in preterm infants born with a gestational age (GA) < 30 weeks, and to identify risk factors associated with PICU admission. This is a retrospective, single-center study including patients between 2016 and 2021. A total of 459 patients were included. Of these, 50 (10.9%) were admitted to the PICU at least once during a follow-up of 3-9 years after NICU discharge. The proportion of children admitted to the PICU varied by GA, ranging from 23.5% at 24 weeks GA to 6.5% at 29 weeks GA. The median (IQR) age of first admission was 4 (3.0-15.5) months. GA < 28 weeks and necrotizing enterocolitis (NEC, grade ≥ 2) were independently associated with an increased risk of PICU admission (OR 2.41, 95%CI 1.22-4.76, p = 0.012; and OR 6.20, 95%CI 3.18-12.10, p < 0.001, respectively).
Conclusion:
In our cohort, one in ten patients born < 30 weeks gestation experienced a PICU admission in their early youth after discharge from the NICU. Extreme prematurity and a diagnosis of NEC were associated with PICU admission.
What Is Known:
• Survival of preterm infants has increased. • Preterm-born children have an increased risk of morbidity, which predisposes them for a higher risk of further health care utilization after neonatal intensive care unit (NICU) discharge.
What Is New:
• In our single-center study, approximately one in ten patients born with a gestational age (GA) < 30 weeks are admitted to the pediatric intensive care unit (PICU) in the years following discharge from the NICU. • Risk factors associated with PICU admission were extreme prematurity (GA < 28 weeks) and necrotizing enterocolitis diagnosis ≥ grade 2.
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