P2.F109: Healthcare utilization in moderate to late preterm infants in first two years of life

Background: Moderate to late preterm (MLPT) infants comprise 84% of the preterm population and have increased morbidity and mortality compared to term infants. This leads to increased financial burden on the parents and the healthcare system. Previous research shows an increased risk of re-hospitalization in MLPT infants in the first few weeks of life. However, there is limited information on long-term healthcare utilization, including hospitalizations, emergency room (ER) visits, and sub-specialty visits. This study aims to describe healthcare utilization beyond initial re-hospitalizations in the first two years in MLPT infants

Methods: This retrospective cohort study included infants born between gestational age (GA) 32 0/7 to 36 6/7 weeks at four hospitals within a single healthcare system from 2016 to 2021. Data regarding longitudinal healthcare encounters was extracted from the electronic health records. Infants who died, had major congenital anomalies, or genetic diagnoses, or had either no follow-up visits after discharge or were transferred out of the healthcare system within 3 months of birth were excluded. ICD10 codes were used to categorize diagnoses. Bivariate analysis of maternal and infant characteristics was compared between groups of infants with short ( < 3 months) and long (3 to 24 months) duration of follow-up in the healthcare system. Healthcare encounters were categorized as hospitalizations, ER visits, well-checks, sick visits, sub-specialty visits, telemedicine visits, therapy sessions, laboratory visits, and other visits, and trends in visits over time were analyzed.

Results: Out of 5228 MLPT infants born during the study period without comorbidities, 1408 (27%) with no follow-up or early transfer out of the system were excluded. Among the 3820 infants included in the analysis, 452 (12%) had healthcare visits in the first 3 months, and 3368 (88%) had encounters between 3 and 24 months of age. Mothers of infants in the longer follow-up group were younger and more likely to have hypertension and mental health-related disorders in pregnancy compared to the short-duration follow-up group (p < 0.05, Table 1). Infants in the longer follow-up group had younger GA, lower birth weight, longer stay during birth hospitalization, and more antibiotic exposure (p < 0.05). There were 43,810 total encounters, of which 16,469 (38%) occurred in the first 6 months and 35,217 (80%) were healthcare encounters outside of pediatrician well checks. About two-thirds of re-hospitalizations and one-third of specialty visits occurred in the first 6 months (Table 2). Overall, 784 (20%) of infants were re-hospitalized at least once, 1272 (33%) had ≥2 emergency visits, and 1328 (35%) had ≥2 subspecialty visits in first 2 years.

Conclusion: In this multi-center, retrospective cohort, nearly one-third of MLPT infants had multiple ER and subspecialty visits, and 20% had at least 1 re-hospitalization in the first 2 years, with most healthcare utilization occurring in the first 6 months.