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Risk factors for hospital readmission among infants with prolonged neonatal intensive care stays

Abstract

Objective

To assess risk factors associated with 30-day hospital readmission after a prolonged neonatal intensive care stay.

Study design

Retrospective analysis of 57,035 infants discharged >14 days from the NICU between 2013 and 2016. Primary outcome was 30-day, all-cause hospital readmission. Adjusted likelihood of readmission accounting for demographic and clinical characteristics, including chronic conditions was also estimated.

Results

The 30-day readmission rate was 10.7%. Respiratory problems accounted for most (31.0%) readmissions. In multivariable analysis, shunted hydrocephalus [OR 2.2 (95%CI 1.8–2.7)], gastrostomy tube [OR 2.0 (95%CI 1.8–2.3)], tracheostomy [OR 1.5 (95%CI 1.2–1.8)], and use of public insurance [OR 1.3 (95%CI 1.2–1.4)] had the highest likelihood of readmission. Adjusted hospital readmission rates varied significantly (p < 0.001) across hospitals.

Conclusions

The likelihood of hospital readmission was highest for infants with indwelling medical devices and public insurance. These findings will inform future initiatives to reduce readmission for high risk infants with medical and social complexity.

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Fig. 1: Multivariable analysis of the likelihood of 30-day hospital readmission in infants receiving neonatal intensive care in children’s hospitals.
Fig. 2: Variation in 30-day readmission rates across hospitals for infants receiving neonatal intensive care in children’s hospitals.

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Funding

Drs. Berry and Hall and Ms. Casto were supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under UA6MC31101 Children and Youth with Special Health Care Needs Research Network. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. The HRSA and HHS had no role in the design and conduct of this study.

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Authors and Affiliations

Authors

Contributions

LHR participated in the initial design of the study, participated in the review of the study, led the manuscript preparation, reviewed, and revised the final version of the manuscript. CCF participated in the initial study design, the review of the study and participated in manuscript preparation and review. KZM and ES and AS participated in the initial study design, the review of the study, and participated in revision of the manuscript. EC participated in the initial study design, data analysis, and in the revision of the manuscript. MH performed the primary data collection and statistical analysis and participated in the revision of the manuscript. JGB conceptualized the study, participated in data analysis and study revision, and revised the final version of the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Laura H. Rubinos.

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Rubinos, L.H., Foster, C.C., Machut, K.Z. et al. Risk factors for hospital readmission among infants with prolonged neonatal intensive care stays. J Perinatol 42, 624–630 (2022). https://doi.org/10.1038/s41372-021-01276-3

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