Large proportion of late preterm infants and older admitted to the NICU

Originally Published By 2 Minute Medicine®. Reused on MPR with permission.

1. Infants ≥ 34 weeks' gestational age (GA) comprised 75% of the median proportions of neonatal intensive care unit (NICU) admissions across level II-IV NICUs, and only 15% of this group were considered to be high acuity.

Evidence Rating Level: 4 (Below Average)

Study Rundown: A recent increase in NICU admissions for larger and more mature infants has been noted, but there is limited data on the clinical characteristics of this population. Among many potential complications, overuse of NICU admissions carries the risk of iatrogenic infection, acute familial stress, and disruption of breastfeeding. The purpose of this cross-sectional study was to evaluate the characteristics of admissions for infants of all gestational ages (GAs) across a variety of NICUs affiliated with the Vermont Oxford Network (VON). Results showed that infants ≥ 34 weeks' GA comprised a large proportion of NICU admissions, accounting for the majority of admissions and over half of all hospitalized days. However, only 15% of these infants were considered to be high acuity, which was defined as death, intubation with assisted ventilation ≥ 4 hours, early bacterial sepsis, major surgery requiring anesthesia, transport to another center for other surgical/medical interventions, hypoxic-ischemic encephalopathy, or a 5-minute Apgar score of <4. Additionally, 10% of infants ≥ 34 weeks' GA had short admissions ≤ 3 days. Limitations included a narrow definition of acuity and use of a convenience sample. For clinicians, the variation in NICU admissions indicates a need for further research on the characteristics of NICU admissions to help generate evidence-based guidelines for appropriate NICU use.

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Click to read the study, published today in Pediatrics

Relevant Reading: Variation in performance of neonatal intensive care units in the United States

In-Depth [cross-sectional study]: NICUs affiliated with the VON were classified as centers with ventilation restrictions (Level II), no surgery or surgery except cardiac bypass (Level III), and the ability to perform all surgeries (Level IV). Infants were classified as extremely preterm ([EPT], 22-25 weeks' GA), very preterm ([VPT], 26-29 weeks' GA), moderate preterm (30-33 weeks' GA), late preterm (34-36 weeks' GA), and term (39-40 weeks' GA). Short stays were defined as discharge ≤ 3 days from the hospital. The study sample include a total of 486 741 infants admitted to 381 NICUs between January 1, 2014 to December 31, 2016. Of these admissions, the median proportions of NICU admissions were 2% (range = 0-23%) for EPT, 5% (0-46%) for VPT, 16% (3-33%) for moderate preterm, 29% (1-45%) for late preterm, 19% (0-33%) for early term, 24% (0-44%) for term, and 3% (0-13%) for postterm infants (p<0.05). Infants ≥ 34 weeks' GA comprised 75% of admissions and 69% of hospitalized days, and only 15% of this age group were considered high acuity and accounted for 31% of initial hospital days. The proportion of high-acuity admissions for all gestational ages was 6% at level I NICUs, 20% at level III NICUs and 37% at level IV NICUs (p<0.0001).

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