Download PDF
Am J Perinatol 2023; 40(13): 1437-1445
DOI: 10.1055/s-0041-1736286
Original Article

Early Readmission following NICU Discharges among a National Sample: Associated Factors and Spending

Janine Bernardo 
1   Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Amaris Keiser
1   Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Susan Aucott
1   Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Lisa R. Yanek
2   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Clark T. Johnson
3   Department of OB/GYN, Anne Arundel Medical Center, Annapolis, Maryland
4   Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
5   Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Pamela Donohue
1   Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Objective Infants admitted to the neonatal intensive care unit (NICU) are at increased likelihood of hospital readmission when compared with non-NICU admitted infants, resulting in appreciable financial and emotional burdens. Early readmission, days to weeks, following NICU discharge, may be preventable. Population-based data identifying potentially modifiable factors and spending associated with early readmission are lacking.

Study Design We conducted a secondary data analysis of privately insured infants in the IBM MarketScan Research Database born from 2011 to 2017 in all 50 states and admitted to the NICU. We examined demographic and clinical characteristics of early readmission within 7 days and between 8 and 30 days following NICU discharge and the payments of NICU and readmission care. Data were analyzed using univariate and multivariable logistic regression.

Results Of the 86,741 NICU survivors analyzed, 3,131 infants (3.6%) were readmitted by 7 days and 2,128 infants (2.5%) between 8 and 30 days. Preterm infants had reduced odds of readmission by 7 days compared with term infants. Infants transferred to a step-down facility (vs. discharge home) and those with congenital anomalies had higher independent odds of readmission by 7 and 8 to 30 days. A higher percentage of NICU infants within the lowest quartile of initial NICU length of stay (LOS) were readmitted by 7 days compared with NICU infants in the middle and highest LOS quartiles (64 vs. 36%, p < 0.01). Median payments of readmissions at 7 and 8 to 30 days was $12,785 and 14,380, respectively.

Conclusion Being term, being transferred to a step-down facility, and having a congenital anomaly were risk factors for early readmission. Shorter initial NICU LOS may be a contributing factor to readmission by 7 days, especially among term infants. These findings identify factors associated with readmission with the hope of preventing early readmission, minimizing spending, and optimizing ideal timing of NICU discharge.

Key Points

  • Preterm infants were less likely than term infants to be readmitted within 7 days after discharge.

  • Transferred infants had higher odds of readmission versus those who were discharged home.

  • Payments for an average single NICU day were $1,000 less than for an average day of readmission.

Keywords

NICU - readmission - spending - length of stay

Supplementary Material



Publication History

Received: 28 June 2021

Accepted: 30 August 2021

Article published online:
11 October 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Harrison W, Goodman D. Epidemiologic Trends in Neonatal Intensive Care, 2007-2012. JAMA Pediatr 2015; 169 (09) 855-862
    CrossrefPubMedGoogle Scholar
  • 2 McLaurin KK, Hall CB, Jackson EA, Owens OV, Mahadevia PJ. Persistence of morbidity and cost differences between late-preterm and term infants during the first year of life. Pediatrics 2009; 123 (02) 653-659
    CrossrefPubMedGoogle Scholar
  • 3 Escobar GJ, Greene JD, Hulac P. et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gestations. Arch Dis Child 2005; 90 (02) 125-131
    CrossrefPubMedGoogle Scholar
  • 4 Ambalavanan N, Carlo WA, McDonald SA, Yao Q, Das A, Higgins RD. Generic Database and Follow-up Subcommittees of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Identification of extremely premature infants at high risk of rehospitalization. Pediatrics 2011; 128 (05) e1216-e1225
    CrossrefPubMedGoogle Scholar
  • 5 Petrou S, Mehta Z, Hockley C, Cook-Mozaffari P, Henderson J, Goldacre M. The impact of preterm birth on hospital inpatient admissions and costs during the first 5 years of life. Pediatrics 2003; 112 (6, pt. 1): 1290-1297
    CrossrefPubMedGoogle Scholar
  • 6 Kuo DZ, Berry JG, Hall M, Lyle RE, Stille CJ. Health-care spending and utilization for children discharged from a neonatal intensive care unit. J Perinatol 2018; 38 (06) 734-741
    CrossrefPubMedGoogle Scholar
  • 7 Underwood MA, Danielsen B, Gilbert WM. Cost, causes and rates of rehospitalization of preterm infants. J Perinatol 2007; 27 (10) 614-619
    CrossrefPubMedGoogle Scholar
  • 8 Miles MS, Holditch-Davis D, Schwartz TA, Scher M. Depressive symptoms in mothers of prematurely born infants. J Dev Behav Pediatr 2007; 28 (01) 36-44
    CrossrefPubMedGoogle Scholar
  • 9 Kuzniewicz MW, Parker SJ, Schnake-Mahl A, Escobar GJ. Hospital readmissions and emergency department visits in moderate preterm, late preterm, and early term infants. Clin Perinatol 2013; 40 (04) 753-775
    CrossrefPubMedGoogle Scholar
  • 10 Lamarche-Vadel A, Blondel B, Truffer P. et al; EPIPAGE Study Group. Re-hospitalization in infants younger than 29 weeks' gestation in the EPIPAGE cohort. Acta Paediatr 2004; 93 (10) 1340-1345
    CrossrefPubMedGoogle Scholar
  • 11 Ray KN, Lorch SA. Hospitalization of early preterm, late preterm, and term infants during the first year of life by gestational age. Hosp Pediatr 2013; 3 (03) 194-203
    CrossrefPubMedGoogle Scholar
  • 12 Hannan KE, Hwang SS, Bourque SL. Readmissions among NICU graduates: Who, when and why?. Semin Perinatol 2020; 44 (04) 151245
    CrossrefPubMedGoogle Scholar
  • 13 Tseng YH, Chen CW, Huang HL. et al. Incidence of and predictors for short-term readmission among preterm low-birthweight infants. Pediatr Int 2010; 52 (05) 711-717
    CrossrefPubMedGoogle Scholar
  • 14 Weiss M, Yakusheva O, Bobay K. Nurse and patient perceptions of discharge readiness in relation to postdischarge utilization. Med Care 2010; 48 (05) 482-486
    CrossrefPubMedGoogle Scholar
  • 15 Escobar GJ, Joffe S, Gardner MN, Armstrong MA, Folck BF, Carpenter DM. Rehospitalization in the first two weeks after discharge from the neonatal intensive care unit. Pediatrics 1999; 104 (01) e2
    CrossrefPubMedGoogle Scholar
  • 16 Schmidt M, Schmidt SA, Sandegaard JL, Ehrenstein V, Pedersen L, Sørensen HT. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015; 7: 449-490
    CrossrefPubMedGoogle Scholar
  • 17 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
    CrossrefPubMedGoogle Scholar
  • 18 Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, Barfield W, Weiss J, Evans S. Risk factors for neonatal morbidity and mortality among “healthy,” late preterm newborns. Semin Perinatol 2006; 30 (02) 54-60
    CrossrefPubMedGoogle Scholar
  • 19 Slimings C, Einarsdóttir K, Srinivasjois R, Leonard H. Hospital admissions and gestational age at birth: 18 years of follow up in Western Australia. Paediatr Perinat Epidemiol 2014; 28 (06) 536-544
    CrossrefPubMedGoogle Scholar
  • 20 Profit J, McCormick MC, Escobar GJ. et al. Neonatal intensive care unit census influences discharge of moderately preterm infants. Pediatrics 2007; 119 (02) 314-319
    CrossrefPubMedGoogle Scholar
  • 21 Edwards EM, Greenberg LT, Ehret DEY, Lorch SA, Horbar JD. Discharge age and weight for very preterm infants: 2005-2018. Pediatrics 2021; 147 (02) e2020016006
    CrossrefPubMedGoogle Scholar
  • 22 Smith VC, Hwang SS, Dukhovny D, Young S, Pursley DM. Neonatal intensive care unit discharge preparation, family readiness and infant outcomes: connecting the dots. J Perinatol 2013; 33 (06) 415-421
    CrossrefPubMedGoogle Scholar
  • 23 Donohue PK, Hussey-Gardner B, Sulpar LJ, Fox R, Aucott SW. Convalescent care of infants in the neonatal intensive care unit in community hospitals: risk or benefit?. Pediatrics 2009; 124 (01) 105-111
    CrossrefPubMedGoogle Scholar
  • 24 O'Brien K, Bracht M, Macdonell K. et al. A pilot cohort analytic study of family integrated care in a Canadian neonatal intensive care unit. BMC Pregnancy Childbirth 2013; 13 (Suppl. 01) S12
    CrossrefPubMedGoogle Scholar
  • 25 Bose CL, LaPine TR, Jung AL. Neonatal back-transport. Cost-effectiveness. Med Care 1985; 23 (01) 14-19
    CrossrefPubMedGoogle Scholar
  • 26 Kunz SN, Dukhovny D, Profit J, Mao W, Miedema D, Zupancic JAF. Predicting successful neonatal retro-transfer to a lower level of care. J Pediatr 2019; 205: 272-276.e1
    CrossrefPubMedGoogle Scholar
  • 27 Behrman RE, Butler AS. eds.; Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: National Academies Press (US); 2007
    Google Scholar
  • 28 Beam AL, Fried I, Palmer N. et al. Estimates of healthcare spending for preterm and low-birthweight infants in a commercially insured population: 2008-2016. J Perinatol 2020; 40 (07) 1091-1099
    CrossrefPubMedGoogle Scholar
  • 29 Phibbs CS, Schmitt SK, Cooper M. et al. Birth hospitalization costs and days of care for mothers and neonates in California, 2009-2011. J Pediatr 2019; 204: 118-125.e14
    CrossrefPubMedGoogle Scholar
  • 30 Bapat R, McClead R, Shepherd E, Ryshen G, Bartman T. Challenges, successes and opportunities for reducing readmissions in a referral-based children's hospital NICU. J Neonatal Perinatal Med 2016; 9 (04) 433-440
    CrossrefPubMedGoogle Scholar
  • 31 Beam KS, Lee M, Hirst K, Beam A, Parad RB. Specificity of International Classification of Diseases codes for bronchopulmonary dysplasia: an investigation using electronic health record data and a large insurance database. J Perinatol 2021; 41 (04) 764-771
    CrossrefPubMedGoogle Scholar
  • 32 Lorch SA, Passarella M, Zeigler A. Challenges to measuring variation in readmission rates of neonatal intensive care patients. Acad Pediatr 2014; 14 (5, suppl) S47-S53
    CrossrefPubMedGoogle Scholar
  • 33 Clark RH, Spitzer AR. Understanding outliers and defining value in neonatal healthcare. J Pediatr 2016; 173: 15-16
    CrossrefPubMedGoogle Scholar
  • 34 Massaro AN, Murthy K, Zaniletti I. et al; Children's Hospital Neonatal Consortium. Intercenter cost variation for perinatal hypoxic-ischemic encephalopathy in the era of therapeutic hypothermia. J Pediatr 2016; 173: 76-83.e1
    CrossrefPubMedGoogle Scholar
  • 35 Campbell BT, Herbst KW, Briden KE, Neff S, Ruscher KA, Hagadorn JI. Inhaled nitric oxide use in neonates with congenital diaphragmatic hernia. Pediatrics 2014; 134 (02) e420-e426
    CrossrefPubMedGoogle Scholar
  • 36 Lax Y, Martinez M, Brown NM. Social determinants of health and hospital readmission. Pediatrics 2017; 140 (05) e20171427
    CrossrefPubMedGoogle Scholar
  • 37 Gupta M, Pursley DM, Smith VC. Preparing for discharge from the neonatal intensive care unit. Pediatrics 2019; 143 (06) e20182915
    CrossrefPubMedGoogle Scholar