Post-discharge healthcare resource utilization and surfactant administration in moderate to late preterm infants with respiratory distress syndrome.

OBJECTIVES

Respiratory distress syndrome (RDS) is common in preterm infants, accounting for significant healthcare resource utilization (HCRU). To address knowledge gaps in mature preterm infants, this study evaluated one-year post-discharge HCRU by surfactant administration.

METHODS

This study included moderate (32 0/7-33 6/7 weeks) and late preterm infants (34 0/7-36 6/7 weeks) with RDS (ICD-10-CM P22.0) requiring >12 h of respiratory support during birth hospitalization at a Kaiser Permanente Hospital in Northern California (2019-2023). Nested logistic regression estimated adjusted odds ratios (aORs) for associations between surfactant receipt and one-year outcomes [any/respiratory emergency department (ED) visits and hospitalizations] across four sequential models: unadjusted; +birth/demographic factors; +clinical severity; +social factors.

RESULTS

Among 1,674 infants, 316 (18.9%) received surfactant and had greater in-hospital severity (moderate-to-severe RDS 23.1% vs. 2.3%; invasive ventilation 25.6% vs. 1.3%; respiratory support ≥94 h 54.2% vs 26.1%; p < 0.001). After discharge, surfactant treated infants were more likely to have any ED visits and hospitalizations compared to non-treated infants. However, associations were attenuated and no longer significant after adjustment for birth/demographics, clinical severity and social factors for any ED visits (aOR:1.28 [0.93, 1.76]) and hospitalizations (aOR:1.33 [0.74, 2.40]). Respiratory ED visits remained elevated after adjustment while estimates for respiratory hospitalizations were imprecise.

CONCLUSION

Among moderate and late preterm infants with RDS, surfactant receipt was associated with greater in-hospital severity. However, adjusting for severity when estimating odds of post-discharge outcomes resulted in small, inconsistent differences. Future studies should consider more precise measures of RDS severity and the impact of post-discharge factors on HCRU.