Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Am J Perinatol. 2023 Oct;40(13):1437-1445. doi: 10.1055/s-0041-1736286. Epub 2021 Oct 11.
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.
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.
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%, < 0.01). Median payments of readmissions at 7 and 8 to 30 days was $12,785 and 14,380, respectively.
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.
· 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..
与非新生儿重症监护病房（NICU）入院的婴儿相比，NICU 入院的婴儿再次入院的可能性更高，这给他们带来了相当大的经济和情感负担。NICU 出院后数周到数周内的早期再入院可能是可以预防的。缺乏基于人群的数据来确定与早期再入院相关的潜在可改变因素和支出。
我们对 2011 年至 2017 年期间在全美 50 个州出生并入住 NICU 的私人保险婴儿进行了 IBM MarketScan 研究数据库的二次数据分析。我们研究了 NICU 出院后 7 天内和 8 至 30 天内的早期再入院的人口统计学和临床特征，以及 NICU 和再入院护理的支付情况。使用单变量和多变量逻辑回归分析数据。
在分析的 86741 名 NICU 幸存者中，有 3131 名婴儿（3.6%）在 7 天内再次入院，2128 名婴儿（2.5%）在 8 至 30 天内再次入院。与足月婴儿相比，早产儿在 7 天内再次入院的可能性较低。与出院回家的婴儿相比，被转移到降阶梯设施的婴儿和患有先天性异常的婴儿在 7 天和 8 至 30 天内再次入院的可能性更高。NICU 婴儿中，最初 NICU 住院时间最短的四分之一婴儿在 7 天内再次入院的比例高于 NICU 婴儿的中间和最高四分之一（64%对 36%，<0.01）。7 天和 8 至 30 天的再入院支付中位数分别为 12785 美元和 14380 美元。
足月、转移到降阶梯设施和患有先天性异常是早期再入院的危险因素。较短的初始 NICU 住院时间可能是 7 天内再入院的一个促成因素，尤其是对足月婴儿而言。这些发现确定了与再入院相关的因素，以期预防早期再入院，减少支出，并优化 NICU 出院的理想时机。
· 与足月婴儿相比，早产儿在出院后 7 天内再次入院的可能性较低。· 与出院回家的婴儿相比，被转移的婴儿再次入院的可能性更高。· 平均 NICU 每天的费用比平均每天的再入院费用少 1000 美元。
