Readmission and ER Visits in VLBW Infants enrolled in a NICU High Risk Follow Up Clinic

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ESPR223
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Abstract: :

Background: The American Academy of Pediatrics recommends that infants discharged from critical care nurseries should be co-managed with the neonatologist and developmental specialist, since they continue to be at high risk for mortality, morbidity, and re-hospitalization.  The NICU Follow Up Clinic at MedStar Georgetown University Hospital (MGUH) provides comprehensive care for NICU graduates from discharge to at least one year of age.  Some infants are not able to follow up at this clinic because of insurance or other reasons.   

Objective: To compare rates of readmission and emergency room (ER) visits of very low birth weight (VLBW, birth weight ≤ 1500 grams) infants followed up in a comprehensive NICU Follow Up Clinic to those who did not.

Study Design:  The charts of VLBW infants discharged from MGUH NICU from 1/1/2016 to 12/31/2018 were reviewed for demographic details, clinical data, and contact information. Patients' parents completed an email and phone survey which inquired if their infant was admitted for at least a day or if there were ER/Urgent care visits, and reasons for admission up to 1 year after discharge. Infants who expired, placed in hospice care, or were transferred before discharge home were excluded.  Results were analyzed with Fischer Exact Test, Student t Test, and multivariate analysis.  This study was approved by the IRB.

Results: Of 126 VLBW infants discharged during the study period, 94 infants who followed up in clinic were compared to 22 who did not.  Ten patients (8%) were lost to follow up.  There was no difference in mean gestational age (28.1 vs 28.4 weeks), mean birth weight (1056 vs 1050g), male gender (46% vs 55%) or in racial distribution (63% vs 64% African American) in the clinic versus the non-clinic patients. Table 1 shows clinic patients had fewer unplanned admissions and fewer ER or urgent care visits compared to non-clinic patients.  The majority of clinic patients had private/commercial insurance (80%) while the non-clinic patients primarily had Medicaid coverage (77%) (p<0.001).  Medicaid infants had an increased risk of hospital readmissions/ER visits compared to private/commercial insurance covered infants (OR 5.22, 95% CI 1.91-15.64, p= 0.002). Among the 94 clinic patients, those who were readmitted were smaller at birth and more preterm than the patients who had no readmissions, but in non- clinic patients, only the gestational age was significantly lower in patients who were readmitted (Table 2). The incidence of bronchopulmonary dysplasia (BPD) was not significantly different among clinic or non-clinic patients (15% vs 9%, p=0.733).   

Conclusions: NICU graduates who follow up in a neonatal high risk clinic had significantly lower rates of hospital admissions and ER/urgent Care visits compared to those who did not attend the clinic.  This study emphasizes the importance and effectiveness of such a clinic to provide comprehensive care for NICU graduates.

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MedStar Georgetown University Hospital
MedStar Georgetown University Hospital
MedStar Health Research Institute
MedStar Georgetown University Hospital

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