739: Postpartum health service utilization by mothers of infants admitted to neonatal intensive care

Abstract

Mothers of infants admitted to the neonatal intensive care unit (NICU) must recover from birth while attending to a critically ill infant. These mothers also have higher rates of chronic disease and perinatal complications than mothers of well babies (MWB). We sought to quantify postpartum health utilization by NICU mothers, compared with MWB. We conducted a retrospective cohort study of mothers delivering liveborn infants at North Carolina Women's Hospital between 7/1/2014 and 6/30/2016. MWB were defined as mothers of infants not admitted to the NICU. NICU mothers were defined as mothers with one or more infants admitted to the NICU. We further subtyped NICU mothers into two groups: Mothers of medically fragile infants (MMFI), defined as NICU length of stay ≥3 days, and mothers of transiently ill infants (MTII), defined as NICU stays <3 days. We ascertained postpartum health service utilization through encounter data recorded in the UNC Health System Epic Electronic Medical Record (EMR) between discharge from the birth hospitalization and 12 weeks postpartum. We used Poisson regression to compare encounter counts and by encounter type, adjusting for mode of delivery, race/ethnicity, payer status, and maternal age. When differences were found between NICU mothers and MWB, we further compared utilization for MMFI vs. MTII. During the study period, 6849 mothers met criteria for inclusion, of whom 5768 were MWB, 743 were MMFI, and 338 were MTII,. Of these 6849 women, 4349 had at least one encounter in the UNC system during the 12-week postpartum period, comprising 9540 encounters. In crude analyses, NICU mothers were more likely to experience each type of encounter, compared with MWB (Table). In adjusted analyses, utilization rates remained significantly higher for NICU mothers for all encounter types other than emergency room visits. Exclusion of women without any postpartum encounters in the UNC Health System did not materially change our results. When we compared MTII with MMFI, we found that MTII had higher rates of outpatient office visits (adj RR 1.29, 95% CI 1.07-1.55) and psychiatry visits (adj RR 1.63, 95% CI 1.13-2.35). Mothers of NICU infants utilize health care at a higher rate in the postpartum period, compared with MWB.