# Risk for pediatric intensive care utilization in children born before 30 weeks of gestation: a single-center study

## TL;DR

This study finds that about 10% of children born before 30 weeks need pediatric intensive care later, with extreme prematurity and a gut condition increasing the risk.

## Contribution

The study identifies PICU admission rates and risk factors for preterm infants born before 30 weeks in a single-center cohort.

## Key findings

- 10.9% of preterm infants born before 30 weeks were admitted to the PICU within 3–9 years after NICU discharge.
- GA < 28 weeks and necrotizing enterocolitis (grade ≥ 2) were independently linked to higher PICU admission risk.
- The PICU admission rate varied by GA, from 23.5% at 24 weeks to 6.5% at 29 weeks.

## Abstract

Extremely preterm-born infants face critical complications after birth that may necessitate health care utilization later in life, including rehospitalization with admission to the pediatric intensive care unit (PICU). However, their specific risk for PICU readmission after discharge from the neonatal intensive care unit (NICU) is currently unclear. Further knowledge on this topic may aid critical care resource planning and parent counseling. In this study, we aimed to determine the rate of PICU admission in preterm infants born with a gestational age (GA) < 30 weeks, and to identify risk factors associated with PICU admission. This is a retrospective, single-center study including patients between 2016 and 2021. A total of 459 patients were included. Of these, 50 (10.9%) were admitted to the PICU at least once during a follow-up of 3–9 years after NICU discharge. The proportion of children admitted to the PICU varied by GA, ranging from 23.5% at 24 weeks GA to 6.5% at 29 weeks GA. The median (IQR) age of first admission was 4 (3.0–15.5) months. GA < 28 weeks and necrotizing enterocolitis (NEC, grade ≥ 2) were independently associated with an increased risk of PICU admission (OR 2.41, 95%CI 1.22–4.76, p = 0.012; and OR 6.20, 95%CI 3.18–12.10, p < 0.001, respectively).

Conclusion: In our cohort, one in ten patients born < 30 weeks gestation experienced a PICU admission in their early youth after discharge from the NICU. Extreme prematurity and a diagnosis of NEC were associated with PICU admission. What is Known:• Survival of preterm infants has increased.• Preterm-born children have an increased risk of morbidity, which predisposes them for a higher risk of further health care utilization after neonatal intensive care unit (NICU) discharge.What is New:• In our single-center study, approximately one in ten patients born with a gestational age (GA) < 30 weeks are admitted to the pediatric intensive care unit (PICU) in the years following discharge from the NICU.• Risk factors associated with PICU admission were extreme prematurity (GA < 28 weeks) and necrotizing enterocolitis diagnosis ≥ grade 2.

What is Known:

• Survival of preterm infants has increased.

• Preterm-born children have an increased risk of morbidity, which predisposes them for a higher risk of further health care utilization after neonatal intensive care unit (NICU) discharge.

What is New:

• In our single-center study, approximately one in ten patients born with a gestational age (GA) < 30 weeks are admitted to the pediatric intensive care unit (PICU) in the years following discharge from the NICU.

• Risk factors associated with PICU admission were extreme prematurity (GA < 28 weeks) and necrotizing enterocolitis diagnosis ≥ grade 2.

The online version contains supplementary material available at 10.1007/s00431-025-06714-4.