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: < 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.