543 - Understanding the impact of preterm birth on Pediatric Intensive Care admissions in England and Wales: A cohort study using novel data linkage

Poster Number: 543
Publication Number: 543.3338

Background: Recent increases in survival following preterm birth may have led to an increasing number of children living with ongoing morbidity.
Preterm birth is associated with hospital readmission after discharge home, however the proportion of children requiring pediatric intensive care unit (PICU) admission, and associated risk factors, are unknown.

Objective: We aimed to examine children born < 32 weeks admitted to PICU following neonatal discharge, up to the age of two years, using large-scale, national linked neonatal and PICU data.

Design/Methods: Data from the National Neonatal Research Database (NNRD) describing all neonatal unit admissions born < 32 weeks in 2013-2018 in England and Wales were linked to PICU admissions using the Paediatric Intensive Care Audit Network (PICANet). PICU admissions as were classified as planned or unplanned. Research ethics approval was granted (ref:20/EE/0220).

We performed descriptive statistics, and Kaplan-Meier plot for cumulative incidence of PICU admission. Logistic regression for unplanned PICU admission used the predictor variables of gestation, sex, birthweight < 10th centile, bronchopulmonary dysplasia requiring oxygen at 36 weeks (BPD), necrotising enterocolitis requiring surgery (NEC), and brain injury (including grade III/IV intraventricular hemorrhage, periventricular leukomalacia). Adjusted odds ratios (aOR) with 95% confidence intervals (95%CI) are presented.

Results: 46,684 babies born < 32 weeks were admitted to neonatal care. 40,690 were discharged home, of whom 2,308 (5.7%) were admitted to PICU before the age of two years (Table 1), the majority (n=1590, 68.8%) within 100 days of neonatal discharge (Figure 1). Children born < 24 weeks had the highest percentage of PICU admission (13.6%).

The association between decreasing gestational age and unplanned PICU admission was observed after adjustment for other factors. Neonatal morbidity was associated with increased odds of unplanned PICU admission: BPD (aOR: 1.37, 95%CI: 1.22 to 1.54), NEC (aOR: 1.39, 95%CI: 1.05 to 1.82), and brain injury (aOR: 1.42, 95%CI: 1.21 to 1.67).

Conclusion(s): More than 1 in 20 children born < 32 weeks require PICU admission after neonatal discharge, this proportion is greater with increasing prematurity, and for children with significant neonatal morbidity. We are working with families to determine how best to communicate this risk. Future work should consider strategies to prevent PICU admission. Understanding the ongoing healthcare requirements of very preterm children will assist planning services within the healthcare system.