The Association of Social Drivers of Health and Neonatal Intensive Care Unit Discharge Delays in Children with Tracheostomy in a Single Center in Rural Minnesota

Introduction: As neonatal intensive care unit (NICU) survival improves, the number of children with tracheostomy, along with those who require home care nursing (HCN), is rising. Discharge delays (DD) are an issue, with an emotional or financial toll on children, families, and the health care system. We aimed to investigate whether social drivers of health like socioeconomic status (SES), race, sex, and medical factors such as gestational age influenced DD for children with tracheostomy. Materials and Methods: We conducted a retrospective chart review of children who underwent tracheostomy in the NICU during a 5-year period. Four authors reviewed electronic medical records for demographics, clinical information, and DD. SES was determined based on the HOUsing-based SocioEconomic Status (HOUSES) index. The Kruskal–Wallis test and Spearman’s correlation were used to assess the association between DD in days and independent variables. In addition, the cohort was divided into 2 groups based on DD ≥30 days to explore factors associated with it descriptively. Results: Sixteen children were included in the study (10 female, 6 male). Ten children were identified as White, and 3 as Black. Three children were not White or Black. Only one child did not experience DD. Median DD was 15 days (interquartile range [IQR]: 13–24; range 0–49). Three children had clinically significant DD (>30 days). The most common cause of DD was waiting for HCN (10/16, 63%, P = 0.065). Race (White versus Black versus other) was associated with DD ( P = 0.045). Female sex ( P = 0.039) was associated with significant DD, while birthweight ( P = 0.19) and HOUSES index ( P = 0.49) were not. Conclusion: DD is a common phenomenon in children with tracheostomy in the NICU, and lack of HCN is the major factor. Race and sex may play a role in DD. HCN shortages and other causes of DD should be further studied and addressed.