360 - REALIZe disparities in regional neonatal technology dependence: a systematic, comprehensive assessment of recent trends

Publication Number: 360.6350

Megan Barcroft, Nationwide Children's Hospital, COLUMBUS, OH, United States; Chance Alvarado, Nationwide Children's Hospital, Columbus, OH, United States; Julie Strominger, Nationwide Children's Hospital, Columbus, OH, United States; Sara Conroy, Nationwide Children's Hospital, Columbus, OH, United States; Tyler J. Gorham, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Elizabeth Bonachea, Nationwide Children's Hospital, Columbus, OH, United States; Roopali Bapat, Nationwide Children's Hospital, Columbus, OH, United States; Stephanie Napolitano, Nationwide Children's Hospital, Columbus, OH, United States

Background: As neonatal intensive care units (NICUs) address disparities in care and outcomes, this work needs longitudinal, local data. This project expands prior work analyzing mortality disparity in our regional 10-NICU network by REALIZe variables: infant Race, Ethnicity, maternal Age, caregiver Language, Insurance, Zip code. This initial morbidity analysis focuses on technology dependence equity.

Objective: To compare regional trends of tracheostomy and gastrostomy tube dependence at NICU discharge by REALIZe variables.

Design/Methods: We performed a retrospective study of all infants admitted to regional NICUs from January 1, 2015 to December 31, 2023. We compiled data from national databases (Vermont Oxford Network, Children’s Hospital Neonatal Database) and electronic health records. We plotted the proportion of infants with tracheostomy or gastrostomy tube, by birthweight and REALIZe variables over time. We assessed U.S. Census Bureau data of median household income by zipcode for both outcomes. Univariable logistic regression was used to estimate the odds ratios and 95% CI using R.

Results: We studied 13,711 infants, 19.6% were Black, 69.4% White, and 11% other race (Table 1). Average gestational age was 36.3 weeks (IQR 33, 39) and birth weight was 2634g (IQR 1797, 3280). Disparities in extreme prematurity and low birth weight categories mirrored national trends. For technology dependence, 4.6% of the population received a gastrostomy tube and 0.8% a tracheostomy tube. To observe longitudinal trends, we plotted gastrostomy and tracheostomy tubes at discharge by REALIZe variables and weight subgroup over time (Figure 1). We saw 50% increased odds of gastrostomy tube at discharge for families who prefer languages other than English compared to those who prefer English (1.14, 2.04) (Figure 2). We observed 40% increased odds of gastrostomy tube at discharge for those with public compared to private insurance (1.20,1.69). For every $10,000 increase in area median household income, there was an 8% decreased odds of gastrostomy tube (0.88,0.95) and 9% decreased odds of tracheostomy tube at discharge (083,1.00). We found no statistical differences in technology dependence by race, ethnicity, maternal age, or high-risk infant mortality zipcode.

Conclusion(s): Gastrostomy tube dependence was higher with preference for languages other than English and public insurance. Infants in higher median income areas had lower odds of gastrostomy and tracheostomy tube dependence. Results suggest additional NICU family support in language and financial resources are needed to ensure equitable outcomes in technology dependence.

Table 1. Demographic and Clinical characteristics by Infant Race


Figure 1. Estimated Odds of Technology Dependence by REALIZe variables


Figure 2. Technology dependence by year, birth weight categories, and REALIZe variables
2a. Gastrostomy tube at discharge. 2b. Tracheostomy tube at discharge.