Improving health care usage in a very low birth weight population

Background: Prematurity is the biggest contributor to admissions in the neonatal intensive care unit (NICU). The period following hospital discharge is a vital continuum for the very low birth weight (VLBW) infant. The objective of this study was to assess the impact of a unique discharge and follow-up process on the outcomes of VLBW infants leaving the NICU. Methods: All outpatient health care usage by VLBW infants born in the study year (cases) was retrospectively tracked through 12 months of age. A cohort of healthy newborn infants were matched by birthdate to each VLBW infant (controls) and similarly tracked. Results: In this study, there were 85 cases and 85 controls. The mean gestational age at birth for the cases was 29.1±2.7 weeks with a mean birth weight of 1079±263 g. That of the controls was 38.9±1.3 weeks and 3202±447 g. Over 90% of both populations had Medicaid coverage. All VLBW infants received care at the Special Care Developmental Follow-Up Clinic. When compared with the controls, VLBW infants discharged from the NICU made fewer acute, unscheduled visits to the Emergency Department or Urgent Care Clinic (2.3±2.5 vs. 3.7±3.5; P=0.007) despite their high-risk medical and social status. Their growth pattern showed significant “catch-up” and was similar to the matched controls at the last scheduled visit for each group. Conclusions: Outcomes including health care utilization in high-risk infants can be improved through meticulous discharge planning and follow-up measures that utilize existing hospital infrastructure to provide affordable comprehensive care.