title: Intensive care unit readmission during childhood after preterm birth with respiratory failure.
abstract: OBJECTIVE
  To determine the incidence and risk factors for readmission to the intensive care unit (ICU) among preterm infants who required mechanical ventilation at birth.
  
  
  METHODS
  We studied preterm newborns (birth weight 500-1250 g) who required mechanical ventilation at birth and were enrolled in a multicenter trial of inhaled nitric oxide therapy. Patients were assessed up to 4.5 years of age via annual in-person evaluations and structured telephone interviews. Univariate and multivariable analyses of baseline and birth hospitalization predictors of ICU readmission were performed.
  
  
  RESULTS
  Of 512 subjects providing follow-up data, 58% were readmitted to the hospital (51% of these had multiple readmissions, averaging 3.9 readmissions per subject), 19% were readmitted to an ICU, and 12% required additional mechanical ventilation support. In univariate analyses, ICU readmission was more common among male subjects (OR 2.01; 95% CI 1.27-3.18), infants with grade 3-4 intracranial hemorrhage (OR 2.13; 95% CI 1.23-3.69), increasing duration of birth hospitalization (OR 1.01 per day; 95% CI 1.00-1.02), and prolonged oxygen therapy (OR 1.01 per day; 95% CI 1.00-1.01). In the first year after birth hospitalization, children readmitted to an ICU incurred greater health care costs (median $69,700 vs $30,200 for subjects admitted to the ward and $9600 for subjects never admitted).
  
  
  CONCLUSIONS
  Small preterm infants who were mechanically ventilated at birth have substantial risk for readmission to an ICU and late mechanical ventilation, require extensive health care resources, and incur high treatment costs.
authors.affiliation: Pediatric Heart Lung Center, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO. Electronic address: peter.mourani@childrenscolorado.org.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Mourani
authors.affiliation: Pediatric Heart Lung Center, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO.
authors.forename: John P
authors.initials: JP
authors.lastname: Kinsella
authors.affiliation: The CRISMA Center (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Gilles
authors.initials: G
authors.lastname: Clermont
authors.affiliation: The CRISMA Center (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Lan
authors.initials: L
authors.lastname: Kong
authors.affiliation: The CRISMA Center (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Perkins
authors.affiliation: The CRISMA Center (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Weissfeld
authors.affiliation: University of Alabama, Birmingham, AL.
authors.forename: Gary
authors.initials: G
authors.lastname: Cutter
authors.affiliation: ZD Associates, Perkasie, PA.
authors.forename: Walter T
authors.initials: WT
authors.lastname: Linde-Zwirble
authors.affiliation: Pediatric Heart Lung Center, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Abman
authors.affiliation: The CRISMA Center (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
authors.affiliation: The CRISMA Center (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Watson
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D012307:Risk Factors