Fellow Boston Children's Hospital Brookline, Massachusetts, United States
Background: Chronic diseases of prematurity can require use of durable medical equipment and supplies (DMES) after hospital discharge. There is a need for information on DMES usage and factors that contribute to DMES needs amongst NICU graduates to improve counseling for families, homegoing planning, and cost analyses related to premature birth. Objective: To measure the prevalence of DMES use after NICU discharge by organ system and function. Design/Methods: This was a retrospective cohort study of the MarketScan Medicaid Database 2016 to 2021, a multi-state Medicaid database with complete billing data for enrolled patients. The study population included all infants with an initial hospital stay in any NICU with 1 year of data available after the date of discharge. The main outcome was DMES use, distinguished with Hotz and colleagues (2023) methodology using Healthcare Common Procedure Coding System codes. DMES billing codes were categorized by organ system and relevant impact on body function, including physiologic necessity. Associations were assessed of categorical gestational age and birth weight, sex, complex chronic conditions (CCCs), number of CCCs, and NICU length of stay with DMES use in the first year after NICU discharge. Logistic regression was used to assess factors associated with physiologically necessary DMES. Results: Of the 63,048 NICU infants in the study cohort, 8.5% were born < 28 weeks gestation and 50.4% between 28 and 36 weeks; 9.1% of infants were born < 1kg and 10.6% between 1 and 1.5kg. During the first year after NICU discharge, 27.2% of infants were prescribed DMES. Respiratory support supplies were the most common DME used (21.7%), including nebulizers (n=9342 infants), oxygen (n=3146), and apnea monitors (n=2912). Gastroenterologic supplies were the second most common (6.6%), including enteral tubes (n=1745), nasogastric tubes (n=1372), and ostomies (n=604). In multivariable modeling, gestational age, birth weight, sex, number of CCCs, and length of stay relative to infants of similar GA were all significantly associated with DMES use.
Conclusion(s): DMES use after a NICU stay is common, and approximately one quarter of infants who spend any time in a NICU will be prescribed some equipment in the first year after discharge. This study provides quantification of contributing risks for DMES use to strengthen prenatal and postnatal counseling, home planning, and improved assessment of the economic burden of prematurity. Requirement of DMES follows expected patterns of increased utilization among infants born at lower gestational age, lower birth weight, and with more chronic conditions.
