Transition from neonatal to paediatric intensive care of very preterm-born children: a cohort study of children born between 2013 and 2018 in England and Wales

Abstract

Objective: Following very preterm birth, some children require ongoing intensive care after the neonatal period and transition directly from neonatal units (NNUs) to paediatric intensive care units (PICUs) around term-corrected age.We aimed to understand, at a national level, characteristics and outcomes of children born very preterm who transitioned directly from NNUs to PICUs.

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

Setting: All NNUs and PICUs in England and Wales.

Patients: Children born <32 gestational weeks between 1 January 2013 and 31 December 2018, admitted to NNUs, and who transitioned directly to PICU without return to NNU at ≥36 weeks corrected gestation age were included.

Main outcome measures: Mortality, length of PICU stay, invasive ventilation in PICU (including via tracheostomy), PICU readmission until 2 years of age.

Results: Direct NNU-to-PICU transitions occurred in 276 babies during the study period. An increasing yearly trend was observed: 36 transitions of babies born in 2013, 65 in 2018.Of this cohort, 22% of children died before their second birthday, 59% of survivors had ≥1 PICU readmission, 33% of children had long stays in PICU (≥28 days) and 25% received tracheostomy ventilation.

Conclusions: An increasing number of very preterm children require ongoing intensive care at the end of their neonatal stay, with high rates of mortality and morbidity. Multidisciplinary involvement and planning around the time of transition from NNU to PICU, informed by national guidance, may be beneficial.

Keywords: Intensive Care Units, Neonatal; Intensive Care Units, Paediatric; Neonatology; Paediatrics; Palliative Care.

Figure 1. Study flowchart. CGA, corrected gestational age; PICU, paediatric intensive care unit.

Figure 2. Number of children transitioned from neonatal-to-paediatric intensive care unit≥36 weeks corrected gestational age, by year and gestation at birth.

Figure 3. Box-and-whisker plot of gestational age at birth by primary diagnosis category on transition to paediatric intensive care unit. Note: ‘body wall’ diagnoses include congenital abdominal wall defects, congenital diaphragmatic hernia, inguinal hernia and codes for open laparotomy procedures.