445 - Health Care Usage through 2 Years Postnatal among Extremely Preterm Infants Following Initial NICU Discharge

Poster Number: 445
Publication Number: 445.121

Leeann Pavlek, Nationwide Children's Hospital, Columbus, OH, United States; Brian Rivera, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Sara Conroy, Ohio State University College of Medicine, Columbus, OH, United States; Carl Backes, Nationwide Children's Hospital, Columbus, OH, United States

Background: The provision of intensive care for infants born at 22 and 23 weeks of gestation has become commonplace in many neonatal intensive care units (NICU). Although the unique inpatient needs of infants born at 22 and 23 weeks of gestation are distinguished from those of more mature extremely preterm infants (EPI; 24 weeks to 276 weeks), few high-quality sources have examined differences in outpatient needs, including use of health care services and follow-up following initial hospital discharge.

Objective: To assess the use of health care services over the first 2 postnatal years among a cohort of EPIs who receive care in a tertiary academic children’s hospital.

Design/Methods: Retrospective cohort study conducted at a large academic children’s hospital (2014 – 2019). Our primary outcome was the number of health care encounters over the first 2 postnatal years following initial NICU discharge. Outpatient health care services were subcategorized as follows: emergency department (ED) usage resulting in admission, ED usage not resulting in admission, outpatient therapy (including occupational, physical, and speech therapies), specialist and/or non-primary care visits, and not otherwise specified. Admission to an intensive care unit (ICU) was used as a marker for the development of a life-threatening condition.

Results: We identified 311 EPIs during the study period, including 55 infants born at 22 and 23 weeks of gestation. The median number of outpatient health care encounters for EPIs was 21 (interquartile range (IQR) 14-36). For children born at 22 and 23 weeks of gestation, we observed a median of 28 outpatient visits (IQR 16–55); children born 24-276 weeks had a median of 20 visits (IQR 13-34; P< 0.01). In the study period, 56.4% children born at 22 and 23 weeks of gestation had at least 1 ED visit associated with an inpatient admission, compared to only 38.3% of children born at 24-276 weeks (P < 0.01). During the study period, we observed no differences in the likelihood for ICU admission between the two groups (5.5% of children born at 22 and 23 weeks vs. 4.7% of children born at 24- 276 weeks of gestation; p=0.73).Conclusion(s): Infants born at 22 and 23 weeks gestation versus more mature EPIs have observed differences in outpatient health care needs following initial NICU discharge. These differences provide an opportunity for policy interventions to improve health care and outcomes, including a post-discharge care clinic and home visiting services.