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Very Preterm Infants with Technological Dependence at Home: Impact on Resource Use and Family.

Abstract：

OBJECTIVE:To examine the impact of medical complexity among very preterm infants on health care resource use, family, and neurodevelopmental outcomes at 18 months' corrected age. METHODS:This observational cohort study of Canadian infants born < 29 weeks' gestational age in 2009-2011 compared infants with and those without medical complexity defined as discharged home with assistive medical technology. Health care resource use and family outcomes were collected. Children were assessed for cerebral palsy, deafness, blindness, and developmental delay at 18 months. Logistic regression analysis was performed for group comparisons. RESULTS:Overall, 466/2,337 infants (20%) needed assistive medical technology at home including oxygen (79%), gavage feeding (21%), gastrostomy or ileostomy (20%), CPAP (5%), and tracheostomy (3%). Children with medical complexity were more likely to be re-hospitalized (OR 3.6, 95% CI 3.0-4.5) and to require ≥2 outpatient services (OR 4.4, 95% CI 3.5-5.6). Employment of both parents at 18 months was also less frequent in those with medical complexity compared to those without medical complexity (52 vs. 60%, p < 0.01). Thirty percent of children with medical complexity had significant neurodevelopmental impairment compared to 13% of those without medical complexity (p < 0.01). Lower gestational age, lower birth weight, bronchopulmonary dysplasia, sepsis, and surgical necrotizing enterocolitis were associated with a risk of medical complexity. CONCLUSION:Medical complexity is common following very preterm birth and has a significant impact on health care use as well as family employment and is more often associated with neurodevelopmental disabilities. Efforts should be deployed to facilitate care coordination upon hospital discharge and to support families of preterm children with medical complexity.

journal_name

Neonatology

journal_title

Neonatology

authors

Nassel D,Chartrand C,Doré-Bergeron MJ,Lefebvre F,Ballantyne M,Van Overmeire B,Luu TM,on behalf of the Canadian Neonatal Network and the Canadian Neonatal Follow-Up Network.

doi

10.1159/000496494

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

363-370

issue

eissn

1661-7800

issn

1661-7819

pii

000496494

journal_volume

115

pub_type

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Very Preterm Infants with Technological Dependence at Home: Impact on Resource Use and Family.