Paediatric intensive care admissions of preterm children born <32 weeks gestation: a national retrospective cohort study using data linkage

Abstract

Objective: Survival of babies born very preterm (<32 weeks gestational age) has increased, although preterm-born children may have ongoing morbidity. We aimed to investigate the risk of admission to paediatric intensive care units (PICUs) of children born very preterm following discharge home from neonatal care.

Design: Retrospective cohort study, using data linkage of National Neonatal Research Database and the Paediatric Intensive Care Audit Network datasets.

Setting: All neonatal units and PICUs in England and Wales.

Patients: Children born very preterm between 1 January 2013 and 31 December 2018 and admitted to neonatal units.

Main outcome measures: Admission to PICU after discharge home from neonatal care, before 2 years of age.

Results: Of the 40 690 children discharged home from neonatal care, there were 2308 children (5.7%) with at least one admission to PICU after discharge. Of these children, there were 1901 whose first PICU admission after discharge was unplanned.The percentage of children with unplanned PICU admission varied by gestation, from 10.2% of children born <24 weeks to 3.3% born at 31 weeks.Following adjustment, unplanned PICU admission was associated with lower gestation, male sex (adjusted OR (aOR) 0.79), bronchopulmonary dysplasia (aOR 1.37), necrotising enterocolitis requiring surgery (aOR 1.39) and brain injury (aOR 1.42). For each week of increased gestation, the aOR was 0.90.

Conclusions: Most babies born <32 weeks and discharged home from neonatal care do not require PICU admission in the first 2 years. The odds of unplanned admissions to PICU were greater in the most preterm and those with significant neonatal morbidity.

Keywords: intensive care units, neonatal; intensive care units, paediatric; neonatology; paediatrics.

Figure 1

Study flowchart. PICU, paediatric intensive care unit.

Figure 2

Sankey diagram showing diagnostic category of first and subsequent paediatric intensive care unit admissions after neonatal discharge home of children born <32 weeks.