778 - Post-natal Transfer Patterns Among Very and Moderate Preterm Infants

Poster Number: 778
Publication Number: 778.248

Sara C. Handley, Children's Hospital of Philadelphia/University of Pennsylvania, Philadelphia, PA, United States; Elizabeth Salazar, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Sarah Kunz, Harvard Medical School, Boston, MA, United States; Scott A. Lorch, The Children's Hospital of Philadelphia/University of Pennsylvnaia, Philadelphia, PA, United States; Erika M.. Edwards, Vermont Oxford Network, Burlington, VT, United States

Background: While post-natal transfer patterns among high-risk (e.g., extremely preterm or surgical) infants have been described, transfer patterns among lower-risk infant populations, such as very and moderate preterm infants, are not well understood. Examining these lower-risk infant transfers may highlight opportunities to optimize risk-appropriate care delivery for these infants.

Objective: To examine initial transfer frequency, indication, timing, and type among very and moderate preterm infants.

Design/Methods: Observational study of the Vermont Oxford Network (VON) all NICU admissions database from 2016-2021 of inborn infants with a gestational age of 28+0/7 to 34+6/7 weeks. Infants’ first transfer were examined. Transfer patterns were assessed by gestational age week, age at transfer (in days and post-menstrual age [PMA]), reason for transfer, and type (up a level, same level, down a level).

Results: Across 467 US VON member hospitals, there were 293,710 eligible infants of whom 12,464 (4.2%) had an initial disposition of transfer. The proportion of infants transferred decreased with increasing gestational age (9.6% [n=1407] at 28 weeks vs 2.4% [n=2626] at 34 weeks) as did the median age at time of transfer (47 days [IQR 30,73] at 28 weeks vs 8 days [IQR 3,16] at 34 weeks). Yet, the median PMA at transfer was 34 or 35 weeks across all gestational ages (Table 1). Overall, the most common reason for transfer was growth/discharge planning (45.0%) followed by medical/diagnostic services (30.2%), though this varied by gestational age with a higher proportion of more preterm infants transferred for medical/diagnostics services rather than growth and discharge planning (Figure 1). Median PMA at transfer was later for infants transferred for chronic care (Table 1). In this cohort, 48.6% of transfers were to a higher-level unit, 11.4% to a same level unit, and 40.1% to a lower-level unit, with indication for transfer reflecting regionalization of care and access to specific services (Figure 2).

Conclusion(s): A large number of very and moderate preterm infants are transferred. The median age of transfer in this cohort is later than prior reports of high-risk infants. Based on transfer type and reason, which differ by gestational age, transfer patterns in this population reflect the provision of risk-appropriate care and most transfers in this cohort do not reflect immediate care needs after birth, but rather access to specific services or unit transfer policies.