96 - Maternal, fetal, perinatal, and postnatal factors predicting the need for Healthcare Utilization by newborn infants in the first month of life – The Neonatal Risk Assessment Score study (NEORAS).

Publication Number: 3092.96

Anirudha Das, Cleveland Clinic Children's, Lakewood, OH, United States; Colleen Schelzig, Division Chair, Pediatric Hospital Medicine, Cleveland, OH, United States; Andrew S. Kern-Goldberger, Cleveland Clinic Children's, Cleveland, OH, United States; HANY ALY, Cleveland Clinic Children's Hospital, Cleveland, OH, United States

Background: Newborn infants discharged from our health system have a readmission rate of 3% and an estimated 7% of neonates visit the Emergency Department (ED) in the first month after birth. Many newborns also require four or more visits to the Pediatrician's office in the first month of life. We sought to quantify risk factors associated with increased healthcare utilization so that we could redirect resources towards infants with higher risk at the time of discharge from the nursery.

Objective: To determine the maternal and neonatal risk factors for hospital readmission, ED visits, and 4 or more office visits in infants in the first month of life.

Design/Methods: In this funded, IRB-approved retrospective cohort study, we examined the three outcomes for infants born during the study period from 2016 to 2021. For each outcome, the data were allocated randomly between variable selection (20%) and model validation (80%). Variable selection was performed using a bootstrap-lasso procedure. The model was then fit on the validation data using the selected variables, and a cross-validated c-statistic was estimated to assess model performance. SAS 9.4 software was used for analysis.

Results: Of the 21,061 subjects were included for analyses, readmission or ED visit rate was 4.5% (n=940); 4 or more office visits at 21% (n=4,324), and the composite of all outcomes, 25.5% (n=5,266). Models for the hospital/ER and composite outcomes had low values of the c-statistic ( < 0.60) and excluded. The 4 or more office visits outcome was modeled separately by mode of delivery. For vaginal births (n=14,997), (4 or more visits = 3,198, 21%), the c-statistic was significant at 0.65 for a model with the following predictors: maximum transcutaneous bilirubin, gestational age, weight loss percentage at discharge, duration of rupture of membranes, maximum heart rate, maternal age at delivery, mother's body mass index (BMI) at delivery, and nulliparity. For c-sections (n= 5,774, 1,065=18% with outcome), the c-statistic was significant at 0.66 for a model with predictors: percent weight loss at discharge, maximum transcutaneous bilirubin level, maternal BMI at delivery, lowest temperature, gestational age, and maximum heart rate.

Conclusion(s): At discharge from the nursery, percentage loss of weight, maximum transcutaneous bilirubin, mother's BMI at delivery, gestational age and maximum heart rate were associated with a higher rate of increased healthcare utilization irrespective of the mode of delivery. We plan to create a risk scoring system to assign to all newborns at discharge to allocate more resources to the higher-risk infants.

Figure 1
Model for 4 or more office visits in infants delivered by vaginal route. Variables include: Max Transcutaneous Bilirubin, Gestational Age in Weeks, Percent Weight loss, ROM time in Hours (log scale), Max Heart Rate, Maternal Age At Delivery, Mother BMI At Delivery, Nulliparous.

Figure 2
Model for 4 or more office visits in infants delivered by c-section route. Variables include: Percent Weight Loss, Max Transcutaneous Bilirubin, Mother BMI At Delivery, Min Temperature, Gestational Age in Weeks, Max Heart Rate.