Transition from neonatal to paediatric intensive care of very preterm-born children: a cohort study of children born 2013-2018 in England and Wales

Objective Following very preterm birth, some children require ongoing intensive care after the neonatal period and transition directly from neonatal units (NNUs) to paediatric intensive care units (PICUs) around term-corrected age. We aimed to understand, at a national level, characteristics and outcomes of children born very preterm who transitioned directly from NNUs to PICUs. Design Retrospective cohort study, using data linkage of National Neonatal Research Database, Paediatric Intensive Care Audit Network (PICANet), and Office for National Statistics datasets. Setting All NNUs and PICUs in England and Wales. Patients Children born <32 gestational weeks between 1/1/2013 and 31/12/2018, admitted to NNUs and who transitioned directly to PICU without return to NNU at ≥36 weeks corrected gestation age. Main outcome measures Mortality, length of PICU stay, invasive ventilation in PICU (including via tracheostomy), PICU readmission until two years of age. Results Direct NNU to PICU transitions occurred in 276 babies during the study period. An increasing yearly trend was observed: 36 transitions of babies born in 2013, 65 in 2018. Of this cohort, 22% of children died before their second birthday, 59% of survivors had ≥1 PICU readmission, 33% of children had long-stays in PICU (≥28 days) and 25% received tracheostomy ventilation. Conclusions An increasing number of very preterm children require ongoing intensive care at the end of their neonatal stay, with high mortality and morbidity. Multidisciplinary involvement and planning around the time of transition from NNU to PICU, informed by national guidance, may be beneficial.