204 Prematurity and paediatric intensive care admissions: cohort study using a novel large-scale data linkage

Objectives

Following increases in survival following preterm birth in recent years¹ there is likely to be an increasing number of children living with ongoing morbidity, who may need admission to a paediatric intensive care unit (PICU) in the first years of life. We aimed to investigate the percentage of children born <32 weeks admitted to PICU following neonatal discharge, up to the age of two years, using a novel linkage of large-scale, national datasets.

Methods

Data from the National Neonatal Research Database (NNRD) describing all neonatal unit admissions born <32 weeks in 2013–2018 in England and Wales were linked to PICU admissions using the Paediatric Intensive Care Network Audit (PICANet).² We performed descriptive statistics, Kaplan-Meier curves, and logistic regression using the following predictors: gestation, age, sex, ethnicity, deprivation, birthweight <10th centile of cohort, antenatal steroids, major surgery during neonatal unit stay, and discharge with home oxygen. Major surgery included intra-abdominal surgery, ventriculo-peritoneal shunts, surgery for retinopathy of prematurity and closure of ductus arteriosus, but excluded surgical central catheter insertion and inguinal hernia repair.

Results

There were 46,808 babies born <32 weeks admitted to neonatal care. 40,789 were discharged home, of whom 2,310 (5.7%) were admitted to PICU before the age of two years, the majority (n=1590, 68.8%) within 100 days of neonatal discharge (figure 1). Children born at 23 weeks had the highest percentage of PICU admission (13.6%) (table 1). The association between decreasing gestational age and PICU admission was observed even after adjustment for other factors. After controlling for other factors including gestational age at birth, the most significant predictor associated with increased adjusted odds ratios (aORs) for PICU admission after neonatal discharge was discharge with home oxygen (aOR 1.65, 95% confidence interval 1.47 to 1.85). Birthweight <10th centile (aOR 1.30) and major surgery during neonatal stay (aOR 1.50) were also significant predictors.

Conclusion

More than 1 in 20 children born <32 weeks require PICU admission after neonatal discharge, after adjustment this proportion was greater among babies with increasing prematurity, birth weight <10th centile, discharge from neonatal care with home oxygen, and surgery during neonatal stay. Healthcare professionals may be able to identify babies at greater risk of requiring PICU following neonatal discharge, particularly those with multi-morbidity. Collaboration with families is needed to determine how best to communicate this risk. Understanding the ongoing healthcare requirements of very preterm children will assist planning services within the healthcare system.

References

British Association of Perinatal Medicine. Perinatal Management of Extreme Preterm Birth Before 27 weeks of Gestation (2019). A BAPM Framework for Practice 2019 [updated 23/10/2019. Available from: https://www.bapm.org/resources/80-perinatal-management-of-extreme-preterm-birth-before-27-weeks-of-gestation-2019. Paediatric Intensive Care National Audit – Universities of Leicester and Leeds. PICANet; 2021 [Available from: https://www.picanet.org.uk/]