Published online April 2, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. e1079-e1087 (doi:10.1542/peds.2006-0899)
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ARTICLE

Neurodevelopmental and Growth Outcomes of Extremely Low Birth Weight Infants Who Are Transferred From Neonatal Intensive Care Units to Level I or II Nurseries

Shabnam Lainwala, PhD, MBBSa, Rebecca Perritt, MSb, Kenneth Poole, PhDb, Betty Vohr, MDa for the National Institute of Child Health and Human Development Neonatal Research Network

a Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island
b Statistical and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina

OBJECTIVE. Transfer of clinically stable infants to level I and II nurseries alleviates demands on NICUs and allows better use of beds and resources. This study compared growth, neurodevelopmental impairments, postdischarge rehospitalization and deaths, and compliance for follow-up assessment at 18 to 22 months' corrected age of extremely low birth weight infants who transferred to level I and II nurseries with those who continued to receive care to discharge in a NICU.

METHODS. A retrospective analysis of prospectively collected data from the National Institute of Child Health and Human Development Neonatal Research Network was performed. Between January 1998 and June 2002, 4896 infants born with birth weights of 401 to 1000 g and cared for in 19 National Institute of Child Health and Human Development Neonatal Research Network centers were included. The sample consisted of 4392 survivors who received continuing care in the NICU to discharge home and 504 infants who were transferred to level I and II nurseries before discharge home. Demographics, perinatal characteristics, growth, and neurodevelopmental impairments were compared. Bivariate and logistic regression analyses were performed.

RESULTS. Transfer of infants to level I and II nurseries was associated significantly with white race, private insurance, outborn status, and lower neonatal morbidities and compliance for follow-up compared with the NICU group. After adjusting for known covariates, transfer to level I and II nurseries was not associated with neurodevelopmental impairments or death; however, it was associated with increased postdischarge rehospitalization.

CONCLUSIONS. Extremely low birth weight infants who are transferred to level I and II nurseries have similar growth and neurodevelopmental outcomes to infants who are discharged from a NICU. They are, however, more likely to be readmitted to the hospital and are less compliant for follow-up. Establishment of consistent guidelines for comprehensive discharge planning for level I and II nurseries may improve follow-up compliance and reduce rehospitalization rates among these infants who are transferred.

Key Words: neurodevelopmental outcomes • ELBW infants • level I and II nurseries • transfer • NICU

Abbreviations: CA—corrected age • ELBW—extremely low birth weight • NICHD—National Institute of Child Health and Human Development • RDS—respiratory distress syndrome • IVH—intraventricular hemorrhage • PVL—periventricular leukomalacia • NEC—necrotizing enterocolitis • ROP—retinopathy of prematurity • BPD—bronchopulmonary dysplasia • NDI—neurodevelopmental impairment • MDI—mental developmental index • PDI—psychomotor developmental index • SIDS—sudden infant death syndrome • OR—odds ratio • CI—confidence interval

Accepted Nov 7, 2006.