P0726 - Early Readmissions following NICU Discharges Among a National Sample: Associated Factors and Cost

Background: Neonatal Intensive Care Unit (NICU) graduates are at increased likelihood of hospital readmission when compared to non-NICU admitted infants, resulting in significant financial and emotional burdens. Some early readmissions following NICU discharge may be preventable. Population-based data identifying factors and costs associated with early readmission are lacking.

Methods: We conducted a secondary data analysis on a cohort of infants admitted to NICUs included in the IBM MarketScan Research Databases. Infants were privately insured, born from 2011-2017 and discharged from NICUs across all 50 states. We examined rates of 7 and 8-30 day readmissions based on demographic and clinical characteristics, using ICD9 and 10 codes. Total gross hospital payment was used for the cost of rehospitalization. Data were analyzed using range and univariate and multivariable logistic regression.

Results: 92,228 NICU survivors were included with discharge data; 36% were full term (FT), 58% preterm (PT), and 6% had unknown gestational age (unkGA). Of 3,768 (4.1%) infants readmitted by 7 days, 45% were FT, 38% PT, and 17% unkGA. Of the 2,403 (2.6%) readmitted between 8-30 days after NICU discharge, more than half (54%) were PT. Infants with a congenital anomaly, sepsis/suspected sepsis, or transferred during NICU stay were at higher risk of being readmitted by 7 days (Table 1). The most common reasons for readmission by 7 days were feeding problems, jaundice, respiratory distress, and sepsis. Infants readmitted by 8-30 days were more likely to have a NICU diagnosis of chronic lung disease (CLD), severe necrotizing enterocolitis (sNEC), congenital anomaly, or utilize medical equipment (Table 1). Most common reasons for readmission included feeding problems and infection. Length of stay (LOS) of NICU hospitalization was significantly shorter for those readmitted by 7 days (2, 1-286) vs readmitted by 8-30 days (14, 1-284) vs never readmitted (9, 1-718); (median, range). Median cost of readmissions at 7 and 8-30 days was $15,985 and $16,009, respectively. Multiple logistic regression models demonstrated that full-term infants discharged from NICU had nearly twice the odds of readmission by 7 days than preterm infants. The only independent predictor of rehospitalization at 8-30 days was congenital anomalies (Table 2).

Conclusions: Full term infants discharged from the NICU are at higher risk of readmission by 7 days than preterm infants, independent of hospital diagnoses. Shorter length of stay of the initial NICU admission of infants readmitted by 7 days may be a contributing factor for readmission. Congenital anomalies were associated with increased risk of readmission by 8-30 days with feeding difficulty and infection as the primary reason for readmission. These findings may help identify potential modifiable factors to prevent early readmission, minimize cost, and maximize ideal timing of NICU discharge.