Use of Medical Resources by Preterm Infants Born at Less than 33 Weeks' Gestation Following Discharge from the Neonatal Intensive Care Unit in Korea

Abstract

This study was aimed to provide data on the use of medical resources by preterm infants following discharge from the neonatal intensive care unit (NICU). The cohort included preterm infants (n=2,351) born at 22-32 weeks' gestation who were discharged from the NICUs of 44 Korean hospitals between April 2009 to March 2010. Mean duration of post-discharge follow-up was 425±237 days. After discharge from the NICU, 94.5% of total infants visited a pediatric outpatient clinic (11.5±9.8 mean visits), 42.9% visited a pediatric clinic for respiratory problems irregularly (4.9±6.6 mean visits), and 31.1% utilized emergency center at least once. Among all visits to the emergency center, 24.7% resulted in readmission and 50.8% of those visits were due to respiratory problems. At least one episode of readmission was required by 33.6% (788/2,346) of total infants, and 18.4% (431/2,346) of total infants were readmitted with respiratory problems at least once. Among all infants readmitted for respiratory problems, 16.2% (70/341) were diagnosed with respiratory syncytial virus infection which accounted for 30.3% of viral etiologies confirmed by laboratory testing. Infants born at <30 weeks' gestation had more frequent total readmission and respiratory readmission than those ≥30 weeks' gestation (2±1.7 vs. 1.7±1.2, P=0.009, 1.8±1.2 vs. 1.5±1.1, 0.027, respectively). Overall, use of medical resources is common, and respiratory problems are the leading cause of use of medical resources. Total readmissions and respiratory readmissions are more frequent in more immature infants.

Keywords: Emergency Service, Respiratory Problems; Hospital; Infant, Premature; Outpatient Clinics; Patient Readmission.

Fig. 1. Study population. Among 2,698 infants born at 22-32 weeks' gestation discharged from the neonatal intensive care unit of 44 Korean hospitals between April 2009 to March 2010, 2,373 infants survived. Excluding 21 infants with incomplete data, 2,35l infants were enrolled.

Fig. 2. Cumulative percent of follow-up duration of preterm infants after discharge from the neonatal intensive care unit (NICU). Mean value and standard deviation of the duration was 425±237 days.

Fig. 3. Days to first readmission following discharge from the neonatal intensive care unit (NICU). The younger the gestational age at birth, the higher the probability of total readmissions and readmissions for respiratory problems (log-rank test for trend P < 0.001). Kaplan-Meier curves are shown for total readmission (A) and readmission for respiratory problems (B). ^*Means a significantly higher probability of readmissions following discharge from the NICU, compared with infants 30-31, and 32 weeks' gestation (Pair-wise comparison, P < 0.05).