Back transport of neonates: effect on hospital length of stay

Introduction: In a regionalized perinatal system, recovering neonates may be back transported from a regional Neonatal Intensive Care Unit (NICU) to community hospitals closer to their residence to convalesce prior to hospital discharge.

Objective: This study evaluates the practice of neonatal back transport for growth and the duration of total hospitalization.

Methods: We conducted a retrospective study comparing length of stay (LOS) for infants back transported from a regional NICU to a level II nursery for convalescent care (BT), with LOS for infants eligible for back transport discharged home from the Regional Center (RC).

Results: A total of 221 infants were studied. BT infants (n=104) had lower birth weights (median; 1955 vs 2700 g, p=0.001), more frequently needed mechanical ventilation (84 vs 65%, p=0.002) and parenteral nutrition (71 vs 55%, p=0.013), less frequently were evaluated by subspecialists (20 vs 59% p=0.0001), and had longer total LOS (median; 20 vs 11 days, p<0.0001) compared to infants discharged home from the RC (n=117). However, in the subgroup with birth weights <or=1500 g (very low birth weight (VLBW)), BT (n=25) infants had similar birth weight (median; 1160 vs 1215 g, p=0.9) compared to those discharged home from the RC (n=24) and did not have a statistically different total LOS (median; 50 vs 56 days, p=0.1). Almost all infants who had major surgeries, treatment for retinopathy of prematurity, seizures, or had severe intra-ventricular hemorrhages were discharged home from the RC. The rates of hospital readmissions or emergency room visits acutely after their discharge to home from the RC or the community hospital were similar.

Conclusions: BT Infants differed based on clinical features compared to premature infants discharged from the RC. VLBW infants, back transported for growth, had similar total LOS compared to similar weight infants discharged home from the RC.