Intensive care unit readmission during childhood after preterm birth with respiratory failure
Peter M Mourani, John P Kinsella, Gilles Clermont, Lan Kong, Amy M Perkins, Lisa Weissfeld, Gary Cutter, Walter T Linde-Zwirble, Steven H Abman, Derek C Angus, R Scott Watson, Prolonged Outcomes after Nitric Oxide (PrONOx) Investigators, M T Coughlin, T T Dremsizov, C J Pidro, M S Roberts, J R Lave, L A Weissfeld, A Perkins, X Yuan, R Hopkins, N Goodrich-Hunsaker, J Sumner, R Couser, M Mammel, R Gurwitch, E Jennings, A Pollock, K Sekar, R Auten, R Goldstein, K Gustafson, H Carriedo, K Freeman, K Freier, H Feldman, C Hart, C Milberger, P Ingram, W M Southgate, S Fields, K Finnegan, J Gerdes, M Gringlass, K Watson, D Hall, C Lebovitz, K Vaver, D Werner, M Cugno, M Pappagallo, T George, L Noble, C Bose, L Bostic, D Marshall, J McKeeman, I Penna, S Sardesai, D Gertsman, M Steffen, D Daily, W Walsh, S Moreland, N Waas, L Fashaw, D Rodden, K Hale, G Addison, S Collins, K Novak, A Reed, B Pruckler, A Law, S Steele, K Mathis, B Gogri, L Anderson, G Bose, R Mayoral, B Jones, H Chinchilla, K Wood, B Smith, K Auten, J Jones, J Lisak, T Mancini, A Schwoebel, M Grous, M McCoy, D McCann, K Corff, K Johnson, G Cress, E Ramthun, K Jennings, G Borders, L Dalton, L Machain, D Wilson, M De la Rosa Trujillo, A Arratoonian, P Meyers, R Gertz, M Maxwell, D Mitchell, W Gehring, T Van Duzer, T Borreck, G Hansen, C Bender, C Daniel, Peter M Mourani, John P Kinsella, Gilles Clermont, Lan Kong, Amy M Perkins, Lisa Weissfeld, Gary Cutter, Walter T Linde-Zwirble, Steven H Abman, Derek C Angus, R Scott Watson, Prolonged Outcomes after Nitric Oxide (PrONOx) Investigators, M T Coughlin, T T Dremsizov, C J Pidro, M S Roberts, J R Lave, L A Weissfeld, A Perkins, X Yuan, R Hopkins, N Goodrich-Hunsaker, J Sumner, R Couser, M Mammel, R Gurwitch, E Jennings, A Pollock, K Sekar, R Auten, R Goldstein, K Gustafson, H Carriedo, K Freeman, K Freier, H Feldman, C Hart, C Milberger, P Ingram, W M Southgate, S Fields, K Finnegan, J Gerdes, M Gringlass, K Watson, D Hall, C Lebovitz, K Vaver, D Werner, M Cugno, M Pappagallo, T George, L Noble, C Bose, L Bostic, D Marshall, J McKeeman, I Penna, S Sardesai, D Gertsman, M Steffen, D Daily, W Walsh, S Moreland, N Waas, L Fashaw, D Rodden, K Hale, G Addison, S Collins, K Novak, A Reed, B Pruckler, A Law, S Steele, K Mathis, B Gogri, L Anderson, G Bose, R Mayoral, B Jones, H Chinchilla, K Wood, B Smith, K Auten, J Jones, J Lisak, T Mancini, A Schwoebel, M Grous, M McCoy, D McCann, K Corff, K Johnson, G Cress, E Ramthun, K Jennings, G Borders, L Dalton, L Machain, D Wilson, M De la Rosa Trujillo, A Arratoonian, P Meyers, R Gertz, M Maxwell, D Mitchell, W Gehring, T Van Duzer, T Borreck, G Hansen, C Bender, C Daniel
Abstract
Objective: To determine the incidence and risk factors for readmission to the intensive care unit (ICU) among preterm infants who required mechanical ventilation at birth.
Study design: We studied preterm newborns (birth weight 500-1250 g) who required mechanical ventilation at birth and were enrolled in a multicenter trial of inhaled nitric oxide therapy. Patients were assessed up to 4.5 years of age via annual in-person evaluations and structured telephone interviews. Univariate and multivariable analyses of baseline and birth hospitalization predictors of ICU readmission were performed.
Results: Of 512 subjects providing follow-up data, 58% were readmitted to the hospital (51% of these had multiple readmissions, averaging 3.9 readmissions per subject), 19% were readmitted to an ICU, and 12% required additional mechanical ventilation support. In univariate analyses, ICU readmission was more common among male subjects (OR 2.01; 95% CI 1.27-3.18), infants with grade 3-4 intracranial hemorrhage (OR 2.13; 95% CI 1.23-3.69), increasing duration of birth hospitalization (OR 1.01 per day; 95% CI 1.00-1.02), and prolonged oxygen therapy (OR 1.01 per day; 95% CI 1.00-1.01). In the first year after birth hospitalization, children readmitted to an ICU incurred greater health care costs (median $69,700 vs $30,200 for subjects admitted to the ward and $9600 for subjects never admitted).
Conclusions: Small preterm infants who were mechanically ventilated at birth have substantial risk for readmission to an ICU and late mechanical ventilation, require extensive health care resources, and incur high treatment costs.
Trial registration: ClinicalTrials.gov NCT00006401.
Conflict of interest statement
The other authors delcare no conflicts of interest.
Copyright © 2014 Mosby, Inc. All rights reserved.
Figures
Source: PubMed