PEDIATRICS Vol. 120 No. 2 August 2007, pp. 455-456 (doi:10.1542/peds.2007-1256)
LETTER TO THE EDITOR |
Effect of Back Transport on Readmissions and Follow-up Care
Mohammad A. Attar, MDDepartment of Pediatrics and Communicable Diseases
University of Michigan
Ann Arbor, MI 48109-0254
Susan L. Bratton, MD, MPH
Department of Pediatrics
University of Utah
Salt Lake City, UT 84108
To the Editor.—
We read with interest the informative report by Lainwala et al.1 They documented no adverse effects on developmental outcomes for a large cohort of back-transported recovering premature infants within regionalized perinatal health care delivery. The multicenter experience reconfirmed the safety of back transport among selected recovering infants who do not require intensive subspecialty services.2
We disagree with a conclusion the authors made that back transport per se influences rehospitalization over a long period of time (18–22 months after discharge from the hospital). The authors pointed out that the most important difference between groups for hospital readmission in their analysis was the need for hernia surgery. Unplanned emergency department visits and hospital readmissions within 2 weeks of discharging these infants from the hospital intuitively seems to be a better indicator of discharge-planning adequacy.
A factor the authors did not evaluate in their multivariate analysis was distance between the family residence and specialized care. Tertiary care centers tend to be in urban areas, and residence in an area served by a level I or II nursery may be confounded by rural or socioeconomic differences rather than medical care issues. We did not find differences in use of "early" emergent medical care for back-transported very low birth weight infants compared with infants discharged from a subspecialty center whose family resided similar distances away from the subspecialty center.2
We also want to emphasize that the process of delivering follow-up care for back-transported infants, as the authors mentioned in their discussion, is complex and includes communication between the subspecialty center, the receiving hospitals, and the parents, access to health care, and parent compliance with the plan. The higher incidence of inappropriate place of birth (outborn) in the back-transported group in the Lainwala et al study suggests a problem in access to health care in that group. Less-than-adequate prenatal care for mothers who do not live adjacent to a subspecialty center is an important predictor of the inappropriate delivery site of their very low birth weight infants.3,4
We have reported that back-transported infants were more likely not to receive needed eye examinations for retinopathy-of-prematurity screening, which supports the findings by Lainwala et al that back transport is associated with less-frequent completion of follow-up care.5 In our local experience, back-transported infants were significantly more likely to get the recommended follow-up eye care if appointments were arranged before discharge from the tertiary center. In the subgroup of those who had prearranged appointments, back-transported infants had similar rates of completed eye care compared with infants who were discharged from our center. Coordinated care for these vulnerable infants requires parent education as well as good communication between providers. Likewise, the back-transfer process requires frequent assessment to ensure that the infants and their parents benefit from being closer to their home before discharge without loss of services they need.
REFERENCES
- Lainwala S, Perritt R, Poole K, Vohr B. Neurodevelopmental and growth outcomes of extremely low birth weight infants who are transferred from neonatal intensive care units to level I or II nurseries. Pediatrics. 2007;119(5) . Available at: www.pediatrics.org/cgi/content/full/119/5/e1079
- Attar MA, Lang SW, Gates MR, Iatrow AM, Bratton SL. Back transport of neonates: effect on hospital length of stay. J Perinatol. 2005;25 :731 –736[CrossRef][Medline]
- Attar MA, Hanrahan K, Lang SW, Gates MR, Bratton SL. Pregnant mothers out of the perinatal regionalization's reach. J Perinatol. 2006;26 :210 –214[CrossRef][Web of Science][Medline]
- Samuelson JL, Buehler JW, Norris D, Sadek R. Maternal characteristics associated with place of delivery and neonatal mortality rates among very-low-birthweight infants, Georgia. Paediatr Perinat Epidemiol. 2002;16 :305 –313[CrossRef][Web of Science][Medline]
- Attar MA, Gates MR, Iatrow AM, Lang SW, Bratton SL. Barriers to screening infants for retinopathy of prematurity after discharge or transfer from a neonatal intensive care unit. J Perinatol. 2005;25 :36 –40[CrossRef][Medline]
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
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