M. Joseph1, M. A. Bartz-Kurycki1, J. K. Chica1, K. Tsao1, M. T. Austin1 1McGovern Medical School at UTHealth,Pediatric Surgery,Houston, TX, USA
Introduction: Approximately 8% of all live births in the US require admission to the neonatal intensive care unit (NICU) after birth. Prior studies have shown that these infants are at significantly increased risk of readmission after discharge with readmission rates ranging from 15-50%. Our prior work identified minority race/ethnicity as the strongest predictor of readmission following NICU discharge in our hospital system. In this study, we aimed to determine the incidence of 90 day hospital readmission for infants discharged from the NICU and determine patient characteristics that increase likelihood of readmission using a large national database.
Methods: The Pediatric Health Information System (PHIS) nationwide was queried from 2016-2018 for patients discharged from the NICU. Deceased patients and those discharged within three days of admission were excluded. Descriptive statistics and univariate and multivariate logistic regression were tabulated utilizing SPSS (v24) to determine factors associated with readmission to the hospital within 90 days of discharge from the NICU.
Results: 86,114 patients were included in the final sample. The majority were non-Hispanic white (NHW) (49.6%) followed by non-Hispanic black (NHB) (15.5%), and Hispanic (14.5%). Most were publically insured (n=51,800, 56%). The median gestational age was 35 weeks (IQ range 26-38) and median birthweight was 2780gm (IQ range 1910-3374gm). 53,914 (63%) were readmitted to the hospital within 90 days of discharge from the NICU. NHB race/ethnicity and the diagnosis of a complex chronic medical condition were associated with increased odds of readmission (OR 1.04, 95% CI 1.01-1.08 and OR 1.04, 95% CI 1.01-1.07, respectively). After controlling for other demographic and clinical factors, only complex chronic medical condition was associated with 90-day readmission (OR 1.05, 95% CI 1.02-1.08).
Conclusions: Infants are readmitted at an alarmingly high rate following discharge to home from the NICU; however, few factors were identified to be associated with readmissions using this dataset. Race/ethnicity may play a role but the causes of readmission are likely multifactorial. These will only be addressed through future study that uses both quantitative and qualitative methods to identify potential modifiable risk factors for readmission in this high risk population.