Abstract
Objectives To describe the demographics, clinical characteristics and referral patterns of premature infants to a regional level IV neonatal intensive care unit (NICU); to determine the prevalence and predictors of back-transport of infants ≤ 32 weeks gestational age in a level IV NICU; for infants not back-transported closer to maternal residence, determine the length of stay beyond attainment of clinical stability. Methods Data (2010–2014) from the Children’s Hospital Neonatal Database and individual chart review for infants ≤ 32 weeks admitted to a level IV NICU whose maternal residence was outside the metro area were included. Bivariate associations of maternal and infant characteristics with back-transport were estimated using two-sample t tests and Fisher’s exact test. Multivariable logistic regression was used to measure independent predictors of back-transport. Clinical stability was defined as the attainment of full volume enteral feedings and low flow nasal cannula. Results A total of 223 infants were eligible for analysis; of whom 26% were back-transported after acute care. In the adjusted analysis, insurance status, distance from maternal residence and gestational age were significantly associated with back-transport. For infants not back-transported closer to maternal residence, median length of stay in the level IV NICU beyond attainment of clinical stability was 28.5 days. Conclusion for Practice Predictors of back-transport include private insurance, greater distance of maternal residence from NICU and younger gestational age. Many preterm infants admitted to a regional NICU for acute care remained hospitalized in a level IV NICU after achieving clinical stability, for which care in a NICU closer to maternal residence may be appropriate.
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Acknowledgements
We thank Matthew Nalty with the Eugene S. Farley, Jr. Health Policy Center for his assistance with creation of the referral map.
Funding
This work was supported by the National Institutes of Health (5T32HD007186-37 to Bourque, SL, trainee).
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Bourque, S.L., Levek, C., Melara, D.L. et al. Prevalence and Predictors of Back-Transport Closer to Maternal Residence After Acute Neonatal Care in a Regional NICU. Matern Child Health J 23, 212–219 (2019). https://doi.org/10.1007/s10995-018-2635-6
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DOI: https://doi.org/10.1007/s10995-018-2635-6