(1320) Intrafacility NICU to PICU Transfer: A Multicenter, Retrospective Cohort Study

Introduction: The epidemiology and characteristics of NICU to PICU transfers in the United States have not been systematically evaluated, including the estimated frequency of transfer and relationships between the timing of transfer, patient characteristics, and post-transfer outcomes.

Methods: We conducted a multicenter, retrospective cohort study from 2016-2022 using the Pediatric Health Information Systems database of children < 5 years of age who underwent intrafacility NICU to PICU transfer without interim transfer to a non-ICU ward or discharge. Primary outcomes were: (1) transfer rate, (2) age at transfer, and (3) post-transfer length of stay (LOS). Clinical features (e.g., demographics, comorbidities, procedural data) were compared by earliest and latest quintiles transfer age. Associations between clinical features and age at transfer and post-transfer LOS were assessed via linear regression models (reporting geometric means).

Results: Of 199,315 NICU encounters studied, 9,918 (5.0%) underwent intrafacility transfer (median center rate: 6.5% [interquartile range: 1.9%-9.1%]). Transfer rates increased annually by 0.5% and exhibited a bimodal distribution with >40% occurring at < 10 days of life and >20% after 100 days of life. Those who underwent transfer had higher inpatient mortality rates than those who remained in the NICU (7.5% vs 3.5%, p< 0.01). As compared to those transferred early (1st quintile of transfer age), those who transferred late (5th quintile) more often underwent tracheostomy (40.2% vs 2.5%) and cardiopulmonary resuscitation (CPR) (7.8% vs 3.9%), and less frequently extracorporeal life support (16.8% vs 3.4%) and total parenteral nutrition (76.5% vs 60.8%) (all p< 0.01). All clinical features studied related to technology dependence and acquired morbidity were associated with longer post-transfer LOS, including tracheostomy (GM: 96 ± 6 vs 21± 0.5 days, p< 0.01) and CPR (GM: 58 ± 6 vs 23 ± 0.5 days, p< 0.01).

Conclusions: Children undergoing intrafacility NICU to PICU transfer exhibit a bimodal distribution for age at transfer. Age at transfer and post-transfer LOS were associated with markers of medical complexity and severity of inpatient trajectory emphasizing the importance of research aimed to optimize multidisciplinary handover and mitigate transfer-related morbidity.