Health Care Utilization after NICU Discharge and Neurodevelopmental Outcome in the First 2 Years of Life in Preterm Infants

Objective The objective of this study was to determine predictors of health care utilization and its association with neurodevelopmental outcome in a recent cohort of preterm infants. Study Design A total of 405 infants (born 2008-2011) seen in neonatal intensive care unit (NICU) follow-up were compared for use of hospitalizations (hosps), emergency room (ER), subspecialties (SS), and results of the Bayley-III. High rate of use was defined as having >1 hosp, ER, or SS. Multiple regression adjusted for the effect of risk factors on high health care use. Results High hosp rate was associated with public health insurance (PHI;p=0.021), severely abnormal head ultrasound (SAHUS;p=0.04) at 1year, and PHI (p=0.011), younger gestational age (GA) (p =0.029) at 2 years. High ER use was associated with PHI, younger GA at 1year (p=0.007 and 0.012) and 2 years (p=0.010 and 0.005). High SS was associated with NICU morbidities including small for GA (p=0.005), retinopathy of prematurity (p=0.001), necrotizing enterocolitis (p=0.03), and SAHUS ( p =0.045). At 20 months, infants with high hosp and SS had higher rates of cerebral palsy and significantly lower mean cognitive, language, and motor scores. Conclusion Health care utilization is high among preterm infants in recent years and significantly associated with worse neurodevelopmental outcome. Further research is needed to determine if health care utilization after NICU discharge is an independent predictor of poor outcome.