In a groundbreaking study published in Pediatric Research, researchers have shed new light on an urgently important issue facing extremely preterm infants and their families: the long-term use of medical technology following discharge from neonatal intensive care units (NICUs). As survival rates improve for these vulnerable infants, a critical question emerges about their continued healthcare needs as they grow beyond the nursery, particularly into toddler age. This study rigorously investigates which inpatient morbidities—diseases or complications experienced during the initial NICU stay—are most strongly linked to the sustained use of medical devices and technology up to two years of age.
Extremely preterm infants—those born at or before 28 weeks of gestational age—represent one of the most delicate patient populations in pediatrics. Despite technological advances in neonatal care that have dramatically improved their survival chances, these infants frequently endure a range of morbidities that can have lasting consequences. Chronic lung disease, severe brain injury, necrotizing enterocolitis, and retinopathy of prematurity are among the most serious inpatient morbidities historically documented in this group. This new study leverages a comprehensive clinical analysis to determine how these inpatient risks directly correlate with the need for ongoing medical technology use—such as tracheostomies, feeding tubes, home oxygen, and other life-sustaining devices—at two years corrected age.
The implications of understanding these associations are profound. Medical technology use after NICU discharge profoundly impacts not only the infant’s health outcomes but also the psychological, physical, and financial strain on families. By clarifying which early morbidities serve as predictors for ongoing technology dependence, neonatal providers can better tailor care plans, anticipate home health needs, and strategically focus early intervention services. This study underscores the importance of extending neonatal care assessment beyond hospital discharge to optimize long-term quality of life.
Methodologically, the study draws on a robust cohort of extremely preterm infants monitored through the first two years of life. Detailed inpatient medical records were evaluated for the presence and severity of key morbidities. Follow-up assessments at toddler age recorded medical technology use, employing rigorous criteria to distinguish types and intensities of devices employed. Advanced statistical models were applied to uncover the relative strength of association between specific inpatient complications and each type of post-discharge medical technology reliance.
One of the most compelling findings was the pronounced link between bronchopulmonary dysplasia (BPD)—a severe form of chronic lung disease—and long-term need for supplemental oxygen and respiratory support equipment. Infants diagnosed with moderate to severe BPD during their NICU stay demonstrated significantly higher rates of home oxygen use at two years. This aligns with existing clinical understanding that prolonged pulmonary morbidity can extend well into early childhood, necessitating sustained respiratory management.
Equally revealing was the study’s analysis of neurological injuries, such as intraventricular hemorrhage and periventricular leukomalacia. These conditions, indicative of brain injury during the critical early neonatal period, were strongly correlated with the use of gastrostomy tubes for feeding and sometimes tracheostomies for airway management beyond infancy. The findings emphasize the profound, multifaceted impact neurological damage imparts on an infant’s ability to independently feed and breathe, often requiring complex technological support long term.
Necrotizing enterocolitis (NEC), another devastating neonatal morbidity marked by intestinal inflammation and necrosis, also emerged as a critical predictor of technology use. Survivors of severe NEC requiring surgical intervention frequently depended on enteral feeding devices well into toddler age, highlighting the gastrointestinal sequelae that persist after NICU discharge. These insights make a compelling case for targeted nutritional and surgical follow-up for this subgroup.
Besides identifying individual morbidities, the study further discusses cumulative morbidity burden. Infants with multiple severe complications during their NICU stay were disproportionately more likely to require combinations of medical technology, indicating a compounded effect. The researchers underline that a holistic view of the infant’s medical history is essential for anticipating care complexity.
The study also explores sociodemographic variables that interplay with inpatient morbidities in predicting technology use. While medical complications primarily drive technology dependence, factors such as socioeconomic status, access to specialized home health services, and parental support systems subtly modulate outcomes. This calls for a multidisciplinary approach to post-discharge planning that integrates social determinants of health.
Intriguingly, the researchers note that a subset of infants with similar inpatient complications did not require technology at two years, suggesting potential resilience factors or effective early interventions that enable some children to reduce dependency. This points toward a promising area for future research, focusing on identifying protective factors and optimizing early therapies.
Clinical care providers will find this study invaluable for its precision in risk stratification. Neonatologists, pediatric pulmonologists, neurologists, and developmental specialists can harness these findings to improve prognostic counseling for families, developing clearer expectations about potential long-term support needs and improving shared decision-making processes.
Health systems and policymakers can leverage this evidence to allocate resources more efficiently. Knowing which inpatient complications most strongly link to technology use can inform both hospital discharge protocols and community-based healthcare programs, ensuring families receive coordinated and comprehensive follow-up care aimed at reducing technology dependence when possible.
This study also bears significant implications for caregivers, who often face daunting challenges managing complex medical devices at home. Recognizing the likelihood and duration of technology use early allows families to access appropriate training, psychological support, and financial assistance programs in a timely manner. By doing so, the burdens of caregiving can be alleviated, and infant outcomes optimized.
Technological innovation might also be stimulated by these findings. Industry stakeholders may be inspired to develop smarter, more user-friendly medical devices tailored for young children who rely on respiratory support or enteral feeding systems, improving both safety and quality of life.
The ethical dimensions of delayed medical technology weaning are implicitly accentuated by this work. Identifying which morbidities necessitate prolonged device use reinforces the imperative to continuously evaluate both risks and benefits of ongoing medical dependency, striving to minimize harm while maximizing developmental potential.
Future research trajectories inspired by this study could include longitudinal studies extending into later childhood or adolescence, examining how early dependency on medical technology influences neurodevelopment, physical growth, and psychosocial adaptation over time.
In summary, this comprehensive investigation into the relationship between inpatient morbidities and medical technology use in extremely preterm infants is a landmark contribution to neonatal and pediatric medicine. It provides a clearer, data-driven picture of the complex journey from fragile beginnings in the NICU to life at home, brimming with technological and caregiving challenges that demand ongoing attention.
As neonatal survival continues to advance globally, insights like those generated by this study will be indispensable to shaping holistic, family-centered care models that anticipate long-term needs and harness early interventions—ultimately fostering healthier futures for the tiniest patients and their loved ones.
Subject of Research: Associations between inpatient morbidities and subsequent use of medical technology at two years among extremely preterm infants.
Article Title: Inpatient morbidities and medical technology use at 2 years among extremely preterm infants.
Article References:
Dorner, R.A., Li, L., Lemmon, M.E. et al. Inpatient morbidities and medical technology use at 2 years among extremely preterm infants. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04671-0
Image Credits: AI Generated
DOI: 16 December 2025
