Clinical Outcomes and Healthcare Resource Utilization in Moderate to Late Preterm Infants With Respiratory Distress Syndrome
Author(s)
Xuezheng Sun, PhD, MSPH1, Dmitry Dukhovny, MD, MPH2, Annie Simpson, PhD3, Sanjida Mowla, MPH1, Aditi Lahiri, MPH4, Dana Edelman, MPH5, Sue Liu, Pharm.D.1, Shelby Corman, PharmD, MS, BCPS3, Daniel Fuentes, Pharm.D.1, Michael Kuzniewicz, MD, MPH5.
1Chiesi, Cary, NC, USA, 2Department of Pediatrics and Division of Neonatology, Oregon Health & Science University, Portland, OR, USA, 3Precision AQ, Bethesda, MD, USA, 4Perinatal Research Unit, Division of Research,, Kaiser Permanente Northern California, Oakland, CA, USA, 5Perinatal Research Unit, Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
1Chiesi, Cary, NC, USA, 2Department of Pediatrics and Division of Neonatology, Oregon Health & Science University, Portland, OR, USA, 3Precision AQ, Bethesda, MD, USA, 4Perinatal Research Unit, Division of Research,, Kaiser Permanente Northern California, Oakland, CA, USA, 5Perinatal Research Unit, Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Presentation Documents
OBJECTIVES: Respiratory distress syndrome (RDS) in preterm infants, managed with respiratory support and surfactant, accounts for significant clinical and economic burden, with most research focusing on extremely or very preterm infants. To address knowledge gaps among more mature preterm infants, this study evaluates clinical outcomes and healthcare resource utilization (HCRU) in this population from discharge to one year following birth.
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 hours of respiratory support during birth hospitalization at Kaiser Permanente Northern California (2019-2023). Post-discharge outcomes, including emergency department (ED) visits, hospitalization, and respiratory medications, were analyzed. Associations with surfactant and gestational age (GA) were evaluated using adjusted relative risks (aRRs) accounting for respiratory support duration and GA or surfactant.
RESULTS: Among 1,674 infants (43.1% moderate;18.9% receiving surfactant), median (IQR) hospital and NICU length of stay (LOS) were 15.6 (9.7-21.8) and 15.4 (9.6-21.6) days, respectively. Moderate preterm and surfactant-treated infants had longer LOS than their counterparts (GA, p<0.01; surfactant, p<0.05). After discharge, 30.9% had an ED visit (16.5% for respiratory/infectious diagnoses), 5.5% were hospitalized (2.3% respiratory/infectious diagnoses), and 8.2% used inhaled bronchodilators. Compared to non-surfactant-treated infants, surfactant-treated infants had higher rates of ED visits (36.1% vs 29.7%, p=0.03), hospitalizations (8.5% vs 4.8%, p<0.01; respiratory/infectious-specific hospitalizations: 4.1% vs 1.9%, p=0.02), and respiratory drug use (11.4% vs 7.4%; p=0.02). However, adjusted analyses showed surfactant was only significantly associated with overall hospitalizations (aRR=1.6, 95% CI:1.0-2.6). Moderate preterm infants had higher hospitalization rates (moderate: 7.1%, late: 4.3%, p=0.01). In adjusted analyses, GA was associated with increased hospitalization risk (aRR=1.6, 95% CI:1.1-2.4).
CONCLUSIONS: Moderate and late preterm infants with RDS face substantial clinical and economic burdens in the first year of life. Surfactant use is associated with worse outcomes, likely reflecting the severity of RDS.
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 hours of respiratory support during birth hospitalization at Kaiser Permanente Northern California (2019-2023). Post-discharge outcomes, including emergency department (ED) visits, hospitalization, and respiratory medications, were analyzed. Associations with surfactant and gestational age (GA) were evaluated using adjusted relative risks (aRRs) accounting for respiratory support duration and GA or surfactant.
RESULTS: Among 1,674 infants (43.1% moderate;18.9% receiving surfactant), median (IQR) hospital and NICU length of stay (LOS) were 15.6 (9.7-21.8) and 15.4 (9.6-21.6) days, respectively. Moderate preterm and surfactant-treated infants had longer LOS than their counterparts (GA, p<0.01; surfactant, p<0.05). After discharge, 30.9% had an ED visit (16.5% for respiratory/infectious diagnoses), 5.5% were hospitalized (2.3% respiratory/infectious diagnoses), and 8.2% used inhaled bronchodilators. Compared to non-surfactant-treated infants, surfactant-treated infants had higher rates of ED visits (36.1% vs 29.7%, p=0.03), hospitalizations (8.5% vs 4.8%, p<0.01; respiratory/infectious-specific hospitalizations: 4.1% vs 1.9%, p=0.02), and respiratory drug use (11.4% vs 7.4%; p=0.02). However, adjusted analyses showed surfactant was only significantly associated with overall hospitalizations (aRR=1.6, 95% CI:1.0-2.6). Moderate preterm infants had higher hospitalization rates (moderate: 7.1%, late: 4.3%, p=0.01). In adjusted analyses, GA was associated with increased hospitalization risk (aRR=1.6, 95% CI:1.1-2.4).
CONCLUSIONS: Moderate and late preterm infants with RDS face substantial clinical and economic burdens in the first year of life. Surfactant use is associated with worse outcomes, likely reflecting the severity of RDS.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO162
Topic
Clinical Outcomes
Topic Subcategory
Relating Intermediate to Long-term Outcomes
Disease
SDC: Pediatrics, SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)