Download PDF
Am J Perinatol 2024; 41(S 01): e1613-e1622
DOI: 10.1055/s-0043-1768069
Original Article

Characteristics and Outcomes of Intrahospital Transfers from Neonatal Intensive Care to Pediatric Intensive Care Units

Lauren Mazur
1   Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
,
Ahmed Veten
2   Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
,
Gary Ceneviva
2   Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
,
Sandeep Pradhan
3   Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
,
Junjia Zhu
3   Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
,
Neal J. Thomas
2   Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
3   Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
,
Conrad Krawiec
2   Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
› Author Affiliations Funding U.S. Department of Health and Human Services, National Institutes of Health, National Center for Advancing Translational Sciences, grant number: UL1 TR002014.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective Critically ill children may be transferred from the neonatal intensive care unit (NICU) to the pediatric intensive care unit (PICU) for further critical care, but the frequency and outcomes of this patient population are unknown. The aims of this study are to describe the characteristics and outcomes in patients transferred from NICU to PICUs. We hypothesized that a higher-than-expected mortality would be present for patients with respiratory or cardiovascular diagnoses that underwent a NICU to PICU transition and that specific factors (timing of transfer, illness severity, and critical care interventions) are associated with a higher risk of mortality in the cardiovascular group.

Study Design Retrospective analysis of Virtual Pediatric Systems, LLC (2011–2019) deidentified cardiovascular and respiratory NICU to PICU subject data. We evaluated demographics, PICU length of stay, procedures, disposition, and mortality scores. Pediatric Index of Mortality 2 (PIM2) score was utilized to determine the standardized mortality ratio (SMR).

Results SMR of 4,547 included subjects (3,607 [79.3%] cardiovascular and 940 [20.7%] respiratory) was 1.795 (95% confidence interval: 1.62–1.97, p < 0.0001). Multivariable logistic regression analysis demonstrated transfer age (cardiovascular: odds ratio, 1.246 [1.10–1.41], p = 0.0005; respiratory: 1.254 [1.07–1.47], p = 0.0046) and PIM2 scores (cardiovascular: 1.404 [1.25–1.58], p < 0.0001; respiratory: 1.353 [1.08–1.70], p = 0.0095) were significantly associated with increased odds of mortality.

Conclusion In this present study, we found that NICU to PICU observed deaths were high and various factors, particularly transfer age, were associated with increased odds of mortality. While the type of patients evaluated in this study likely influenced mortality, further investigation is warranted to determine if transfer timing is also a factor.

Key Points

  • NICU patients may be transitioned to the PICU.

  • NICU to PICU observed deaths were high.

  • Transfer timing may be a factor.

Keywords

critical care - outcomes - pediatrics - transfer

Supplementary Material



Publication History

Received: 08 August 2022

Accepted: 24 February 2023

Article published online:
10 April 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Blencowe H, Cousens S, Oestergaard MZ. et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012; 379 (9832): 2162-2172
    CrossrefPubMedGoogle Scholar
  • 2 Oster ME, Lee KA, Honein MA, Riehle-Colarusso T, Shin M, Correa A. Temporal trends in survival among infants with critical congenital heart defects. Pediatrics 2013; 131 (05) e1502-e1508
    CrossrefPubMedGoogle Scholar
  • 3 Mwaniki MK, Atieno M, Lawn JE, Newton CR. Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet 2012; 379 9814 445-452
    CrossrefPubMedGoogle Scholar
  • 4 Davidson LM, Berkelhamer SK. Bronchopulmonary dysplasia: chronic lung disease of infancy and long-term pulmonary outcomes. J Clin Med 2017; 6 (01) 4
    CrossrefPubMedGoogle Scholar
  • 5 Liu L, Johnson HL, Cousens S. et al; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012; 379 (9832): 2151-2161
    CrossrefPubMedGoogle Scholar
  • 6 Glass HC, Costarino AT, Stayer SA, Brett CM, Cladis F, Davis PJ. Outcomes for extremely premature infants. Anesth Analg 2015; 120 (06) 1337-1351
    CrossrefPubMedGoogle Scholar
  • 7 Tennant PWG, Pearce MS, Bythell M, Rankin J. 20-year survival of children born with congenital anomalies: a population-based study. Lancet 2010; 375 (9715): 649-656
    CrossrefPubMedGoogle Scholar
  • 8 Cotten CM, Oh W, McDonald S. et al; NICHD Neonatal Research Network. Prolonged hospital stay for extremely premature infants: risk factors, center differences, and the impact of mortality on selecting a best-performing center. J Perinatol 2005; 25 (10) 650-655
    CrossrefPubMedGoogle Scholar
  • 9 Johnson JT, Wilkes JF, Menon SC. et al. Admission to dedicated pediatric cardiac intensive care units is associated with decreased resource use in neonatal cardiac surgery. J Thorac Cardiovasc Surg 2018; 155 (06) 2606-2614.e5
    CrossrefPubMedGoogle Scholar
  • 10 Crawford K, Kamupira SZ, Morley S, Kelsall AW. G36(P) Outcomes of infants transferred from the neonatal intensive care to the paediatric ward and paediatric intensive care after 44 weeks corrected gestational age. Arch Dis Child 2018; 103 (suppl 1): A14-A14
    PubMedGoogle Scholar
  • 11 Catlin A. Extremely long hospitalizations of newborns in the United States: data, descriptions, dilemmas. J Perinatol 2006; 26 (12) 742-748
    CrossrefPubMedGoogle Scholar
  • 12 Ali N, Sawyer T, Barry J, Grover T, Ades A. Resuscitation practices for infants in the NICU, PICU and CICU: results of a national survey. J Perinatol 2017; 37 (02) 172-176
    CrossrefPubMedGoogle Scholar
  • 13 Ibiebele I, Algert CS, Bowen JR, Roberts CL. Pediatric admissions that include intensive care: a population-based study. BMC Health Serv Res 2018; 18 (01) 264
    CrossrefPubMedGoogle Scholar
  • 14 Tripathi S, Kim MC. 511: variations in outcomes based on the source of admission to the PICU: a review of the VPS database. Crit Care Med 2021; 49 (01) 247
    CrossrefPubMedGoogle Scholar
  • 15 Shann F, Pearson G, Slater A, Wilkinson K. Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med 1997; 23 (02) 201-207
    CrossrefPubMedGoogle Scholar
  • 16 Long JB, Fiedorek MC, Oraedu O, Austin TM. Neonatal intensive care unit patients recovering in the post anesthesia care unit: an observational analysis of postextubation complications. Paediatr Anaesth 2019; 29 (12) 1186-1193
    CrossrefPubMedGoogle Scholar
  • 17 Mansel KO, Chen SW, Mathews AA, Gothard MD, Bigham MT. Here and gone: rapid transfer from the general care floor to the PICU. Hosp Pediatr 2018; 8 (09) 524-529
    CrossrefPubMedGoogle Scholar
  • 18 Combes A, Luyt CE, Trouillet JL, Chastre J, Gibert C. Adverse effect on a referral intensive care unit's performance of accepting patients transferred from another intensive care unit. Crit Care Med 2005; 33 (04) 705-710
    CrossrefPubMedGoogle Scholar
  • 19 Arthur KR, Kelz RR, Mills AM. et al. Interhospital transfer: an independent risk factor for mortality in the surgical intensive care unit. Am Surg 2013; 79 (09) 909-913
    CrossrefPubMedGoogle Scholar
  • 20 Durairaj L, Will JG, Torner JC, Doebbeling BN. Prognostic factors for mortality following interhospital transfers to the medical intensive care unit of a tertiary referral center. Crit Care Med 2003; 31 (07) 1981-1986
    CrossrefPubMedGoogle Scholar
  • 21 Odetola FO, Rosenberg AL, Davis MM, Clark SJ, Dechert RE, Shanley TP. Do outcomes vary according to the source of admission to the pediatric intensive care unit?. Pediatr Crit Care Med 2008; 9 (01) 20-25
    CrossrefPubMedGoogle Scholar
  • 22 Gregory CJ, Nasrollahzadeh F, Dharmar M, Parsapour K, Marcin JP. Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions. Pediatrics 2008; 121 (04) e906-e911
    CrossrefPubMedGoogle Scholar
  • 23 Sekar RP. Epidemiology of arrhythmias in children. Indian Pacing Electrophysiol J 2008; 8 (Suppl. 1): S8-S13
    PubMedGoogle Scholar
  • 24 Clark R, Powers R, White R, Bloom B, Sanchez P, Benjamin Jr DK. Nosocomial infection in the NICU: a medical complication or unavoidable problem?. J Perinatol 2004; 24 (06) 382-388
    CrossrefPubMedGoogle Scholar
  • 25 Joyce EL, Crana CM, Yabes J, Kellum JA. Validation of an electronic Pediatric Index of Mortality 2 score in a mixed quaternary PICU. Pediatr Crit Care Med 2020; 21 (08) e572-e575
    CrossrefPubMedGoogle Scholar
  • 26 Duke G, Green J, Briedis J. Survival of critically ill medical patients is time-critical. Crit Care Resusc 2004; 6 (04) 261-267
    PubMedGoogle Scholar
  • 27 Biban P, Spaggiari S. “Cohabitation” between NICU and PICU. J Matern Fetal Neonatal Med 2011; 24 (suppl 1): 91-93
    CrossrefPubMedGoogle Scholar
  • 28 Fuller C, Wineland AM, Richter GT. Update on pediatric tracheostomy: indications, technique, education, and decannulation. Curr Otorhinolaryngol Rep 2021; 9 (02) 188-199
    CrossrefPubMedGoogle Scholar