Am J Perinatol 2022; 39(06): 646-651
DOI: 10.1055/s-0040-1718572
Original Article

The Changing Landscape in Pediatric Hospitals: A Multicenter Study of How Pediatric Chronic Critical Illness Impacts NICU Throughput

Renee D. Boss
1   Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
2   Berman Institute of Bioethics, Baltimore, Maryland
Carrie M. Henderson
3   Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
4   Center for Bioethics and Medical Humanities, Jackson, Mississippi
Elliott M. Weiss
5   Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
6   Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington
Alison Falck
7   Division of Neonatology, University of Maryland School of Medicine, Baltimore, Maryland
Vanessa Madrigal
8   Department of Pediatrics, Children's National Medical Center, Washington, Dist. of Columbia
Miriam C. Shapiro
9   Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, Minnesota
Erin P. Williams
2   Berman Institute of Bioethics, Baltimore, Maryland
Pamela K. Donohue
1   Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
10   Department of Population and Families, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
on behalf of the Pediatric Chronic Critical Illness Collaborative › Author Affiliations


Objective Pediatric inpatient bed availability is increasingly constrained by the prolonged hospitalizations of children with medical complexity. The sickest of these patients are chronic critically ill and often have protracted intensive care unit (ICU) stays. Numbers and characteristics of infants with chronic critical illness are unclear, which undermines resource planning in ICU's and general pediatric wards. The goal of this study was to describe infants with chronic critical illness at six academic institutions in the United States.

Study Design Infants admitted to six academic medical centers were screened for chronic, critical illness based on a combination of prolonged and repeated hospitalizations, use of medical technology, and chronic multiorgan involvement. Data regarding patient and hospitalization characteristics were collected.

Results Just over one-third (34.8%) of pediatric inpatients across the six centers who met eligibility criteria for chronic critical illness were <12 months of age. Almost all these infants received medical technology (97.8%) and had multiorgan involvement (94.8%). Eighty-six percent (115/134) had spent time in an ICU during the current hospitalization; 31% were currently in a neonatal ICU, 34% in a pediatric ICU, and 17% in a cardiac ICU. Among infants who had been previously discharged home (n = 55), most had been discharged with medical technology (78.2%) and nearly all were still using that technology during the current readmission. Additional technologies were commonly added during the current hospitalization.

Conclusion Advanced strategies are needed to plan for hospital resource allocation for infants with chronic critical illness. These infants' prolonged hospitalizations begin in the neonatal ICU but often transition to other ICUs and general inpatient wards. They are commonly discharged with medical technology which is rarely weaned but often escalated during subsequent hospitalizations. Identification and tracking of these infants, beginning in the neonatal ICU, will help hospitals anticipate and strategize for inpatient bed management.

Key Points

  • 35% of inpatients with chronic critical illness are infants.

  • Nearly 90% of these infants spend some time in an intensive care unit.

  • 78% are discharged with medical technology.

* A complete list of nonauthor participating investigators appears in the [Supplementary Material], available in the online version.

Supplementary Material

Publication History

Received: 29 April 2020

Accepted: 07 September 2020

Article published online:
19 October 2020

© 2020. Thieme. All rights reserved.

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