180: Preterm Infant Journeys in a Canadian Regionalized Health Services Context

In Canada, Neonatal Intensive Care Units (NICU) and Neonatal Follow-Up (NFU) programs are regionalized health services. Families who experience preterm birth (infants <29 weeks gestation) therefore travel greater distances to access specialized health services. The effect of distance from NICU, inter-NICU transfers and infant factors on attendance at NFU programs has not been studied at a national level. To determine distances from home to NICU, home to NFU and factors affecting attendance rates at NFU programs in Canada. Canadian-born infants born <29 weeks gestation between January 1 and December 31, 2010 were followed from NICU admission through to 18 months corrected age (CA). Data were tracked through the integrated Canadian Neonatal Network (CNN) and Canadian Neonatal Follow-Up Network (CNFUN) databases. Mean travel distance was calculated using postal code data. Significance was assessed based on attendance status using Pearson Chi-Square for categorical variables and ANOVA for continuous variables. Of 1661 NICU admissions, 462 were excluded due to mortality, transfer out of country and NICU without a NFU program. Of the remaining 1199 infants, 950 (79.2%) attended NFU. Infant factors associated with NFU attendance were lower gestational age (P=0.02), lower mean birth weight (P<0.01) and higher severity of illness (SNAP II score, bronchopulmonary dysplasia [O2 at 36 weeks CA], P<0.01, retinopathy of prematurity [Grade 3 or higher], P=0.01 and intraventricular hemorrhage [Grade 3 or 4], P=0.03). The median distance in kilometres to NICU was 23.4 [IQR 8.6 to 90.3] ranging from 6.4 to 195.8 between NICUs and to NFU was 22.9 [IQR 8.8 to 75] range 4.3 to 265.1. Travel distance, number of inter-NICU transports and infant surgical necrotizing enterocolitis status were not associated with attendance. Families of preterm infants, on average, travel considerable distances to access health services. Despite this, attendance at NFU programs was associated with infant factors rather than travel distance. The outcome of this study provides new insight into Canadian attendance rates and infants who are less likely to attend NFU.