NICU Follow Up and Neurodevelopment 6: The NICU Stay and Outcomes
59 - The prevalence of neonatal multimorbidity and associated 24-month outcomes among ELBW infants
Monday, May 1, 2023
9:30 AM – 11:30 AM ET
Poster Number: 59 Publication Number: 59.446
Jonathan S. Litt, Beth Israel Deaconess Medical Center, Boston, MA, United States; Mandy Belfort, Brigham and Women's Hospital, Boston, MA, United States; Erika M.. Edwards, Vermont Oxford Network, Burlington, VT, United States; Charles Mercier, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States; Henning Tiemeier, Harvard T.H. Chan School of Public Health, Boston, MA, United States
Neonatologist Beth Israel Deaconess Medical Center Boston, Massachusetts, United States
Background: Children born extremely low birth weight (ELBW; < 1,000 g) are at risk for a constellation of neonatal morbidities, each of which is associated with excess health service use and poor neurodevelopment. Though common, the prevalence and impact of neonatal multimorbidity – the co-occurrence of multiple health conditions across organ systems – is not well-characterized in contemporary cohorts. Objective: We aimed to report the prevalence of neonatal multimorbidity in a large, contemporary cohort of ELBW infants and describe associated post-discharge service use, rehospitalization, and neurodevelopmental impairment at 24 months of agecorrected for gestation at birth. Design/Methods: Our sample included infants born 2010-2019 in 64 North American centers contributing to the Vermont Oxford Network ELBW Follow-up database. Eligible infants for clinical follow-up were born 401-1000 grams or 22 0/7-27 6/7 weeks’ gestation. We used an established definition of neonatal morbidity as having any of the following: bronchopulmonary dysplasia (BPD), grade 3-4 intraventricular hemorrhage, periventricular leukomalacia, stage 3-4 retinopathy of prematurity, any late infection, necrotizing enterocolitis, spontaneous intestinal perforation, and discharge weight < 10th percentile. Outcomes at 24 months included: 1) use of any medical or specialized therapeutic services, 2) rehospitalization, and 3) score < 70 on any subdomain of the Bayley Scales of Infant Development. Results: There were 19,781 ELBW eligible infants surviving to NICU discharge. BPD and discharge weight < 10th percentile were the most common morbidities (Table 1). Of the 19,693 surviving to age 24 months, 7,521 participated in follow-up (38%). While 25% had no morbidities, nearly 38% had one morbidity and 37% had two or more (Table 2). The majority (5,358, 73%) received at least one medical or therapeutic support after NICU discharge, such as home oxygen therapy, enteric tube feeding, or speech therapy. There were 2,673 (36.3%) infants who had at least one rehospitalization and 1,226 (18.9%) with developmental impairment. A rising morbidity count was associated with an incrementally higher proportion of children with each 24-month outcome (Figure 1).
Conclusion(s): Neonatal multimorbidity is common among ELBW infants and is associated with increased service use, rehospitalization, and developmental impairment. Characterizing the patterns of multiple morbidities and their cumulative or synergistic effects on later outcomes is key to anticipating service needs after NICU discharge, counseling families, and supporting optimal health and development over time.
