Author
Pub year
Organization
Group studied
Years studied
Time frame after discharge
N
Readmission rate (%)
Term admission rate if presented (%)
United States studies
Lorch [49]
2014
California
23–34
1995–2009
7 days
343,625
2.2
Goyal [68]
2013
California
34–36, vaginal births
1993–2005
7 days
231,831
3.3
Lorch [49]
2014
California
23–34
1995–2009
14 days
343,625
3.3
Ray [20]
2013
California
24–36
1993–2005
14 days
702,468
3.6
Escobar [22]
1999
Kaiser Permanente, Northern California
24–33
1992–1995
14 days
2328
3.4
2.2
McLaurin [19]
2009
US, Commercially insured
33–36
2004
15 days
1683
3.8
1.3
Lorch [49]
2014
California
23–34
1995–2009
30 days
343,625
5.5
Ray [20]
2013
California
24–36
1993–2005
30 days
702,468
5.3
Kuzniewicz [18]
2013
Kaiser Permanente, Northern California
31–37
2003–2012
30 days
23,190
6.8
3.3
Moyer [69]
2014
Cincinnati
34–36
2009
28 days
1861
3.6
Young [25]
2013
Intermountain Health Care (Utah)
34–36
2000–2010
28 days
19,081
3.5
1.5
Lorch [49]
2014
California
23–34
1995–2009
90 days
343,625
9.9
Ray [20]
2013
California
24–36
1993–2005
90 days
702,468
8.8
Lorch [3]
2010
Kaiser Permanente, Northern California
24–33
1998–2001
1 year
892
37
Smith [70]
2004
Kaiser Permanente, Northern California
24–33, BPD
1995–1999
1 year
238
26.7
Ray [42]
2010
Kaiser Permanente, Northern California
24–34
1998–2001
1 year
663
19
Lorch [49]
2014
California
23–34
1995–2009
1 year
343,625
19
Ray [20]
2013
California
24–36
1993–2005
1 year
702,468
13.4
Furman [17]
1996
Rainbow Babies, Cleveland
VLBW, BPD
1988–1990
1 year
98
50
McLaurin [19]
2009
US, Commercially insured
33–37
2005
1 year
1683
15.2
7.9
Morris [21]
2005
NICHD NRN
ELBW
1998–2000
18–22 months
1405
49
Ambalavanan [24]
2011
NICHD NRN
ELBW
2002–2005
18–22 months
3787
45
International studies
Stephens [27]
2016
New South Wales, Australia
24–33
2001–2011
30 days
19,901
16.2
3.4
Slimings [71]
2014
Western Australia
24–37
1980–2010
30 days
44,650
6.2
Tseng [72]
2010
Taiwan
24–37
2000–2002
31 days
18,421
13.5
Martens [23]
2004
Manitoba
24–37
1997–2001
6 weeks
4492
7.7
3.7
Lamarche-Vadel [73]
2004
EPIPAGE
24–28
1997
9 months
376
47.4
Stephens [27]
2016
New South Wales, Australia
24–33
2001–2011
1 year
19,901
43.6
16.8
Gray [47]
2006
Christchurch Women’s hospital
24–32
1998–2000
1 year
100
40
12
Elder [26]
1999
Western Australia
24–33
1990–1991
1 year
538
42
Chien [16]
2002
National Taiwan Hospital
ELBW
1993–1998
2 years
60
72
Doyle [15]
2003
Royal Women’s Hospital, Melbourne, Australia
ELBW
1997
2 years
72
66
23
Ralser [74]
2012
Northern Tyrol, Austria
24–32
2003–2008
2 years
377
40.1
Some of these studies report on the primary diagnoses for readmissions in prematurely born infants [15–26]. The majority of early readmissions within 7–14 days of NICU discharge are for jaundice and feeding difficulties, especially in infants born at a gestational age (GA) between 34 and 36 weeks. In the first year after discharge, respiratory diagnoses and infections make up the majority of admissions, regardless of country or years of birth.
Impact of Gestational Age and Infant Complications
As expected, younger GA and the presence of common complications of preterm birth are associated with a higher risk of readmission at all time periods after discharge (Tables 2 and 3). In general, rates of readmission in infants born at a gestational age between 24 and 28 weeks have a threefold to fourfold increase in readmissions compared with moderately preterm infants born at a GA between 32 and 34 weeks, and a fivefold to tenfold increase rate compared with infants born at term [18, 27]. Readmissions within 7–14 days of discharge in infants born between 32 and 36 weeks GA are elevated in several studies compared to infants born at an earlier GA, likely secondary to discharge of these moderate to late preterm infants at a chronological age that places them at risk for readmission secondary to jaundice or feeding disorders. The best example of this changing risk of readmission at various time periods is shown in the study of Ray et al. [20]. Using data from over 7 million births in California over a 13-year period, Fig. 1 shows the declining trend in hospital readmissions with older gestational ages, except for a hump in readmission risk within 14 days of discharge in the infants born at a GA between 34 and 36 weeks. These odds ratios remain increased compared to term infants for all GA below 38 weeks.
Table 2
Impact of gestational age on readmission rates
Author | Years studied | Readmission time period | Gestational age group | Rate (%) |
---|---|---|---|---|
Lorch [49] | 1995–2009 | 7 days | < 28 | 2.6 |
29–32 | 2.1 | |||
33–34 | 2.2 | |||
Lorch [49] | 1995–2009 | 14 days | < 28 | 4.1 |
29–32 | 3.2 | |||
33–34 | 3.1 | |||
Ray [20] | 1993–2005 | 14 days | < 28 | 3.7 |
28–32 | 3.6 | |||
Lorch [49] | 1995–2009 | 30 days | < 28 | 6.7 |
29–32 | 5.2 | |||
33–34 | 4.9 | |||
Ray [20] | 1993–2005 | 30 days | < 28 | 6 |
28–32 | 5 | |||
Kuzniewicz [18] | 2003–2012 | 30 days | 31–33 | 2.9 |
34–36 | 8 | |||
Lorch [49] | 1995–2009 | 90 days | < 28 | 12.2 |
29–32 | 9.9 | |||
33–34 | 9.3 | |||
Ray [20] | 1993–2005 | 90 days | < 28 | 10.6 |
28–32 | 8.2 | |||
Ray [42] | 1998–2001 | 1 year | < 28 | a |
Lorch [49] | 1995–2009 | 1 year | < 28 | 20.3 |
29–32 | 19.2 | |||
33–34 | 18.7 | |||
Ray [20] | 1993–2005 | 1 year | < 28 | 16 |
28–32 | 12.5 | |||
Stephens [27] | 2001–2011 | 30 days | 24–27 | 30.7 |
28–31 | 19.9 | |||
32–33 | 10.1 | |||
Slimings [71] | 1980–2010 | 30 days | < 28 | 2.3 |
28–31 | 4 | |||
32–33 | 8.9 | |||
34–36 | 8.9 | |||
Tseng [72] | 2000–2002 | 31 days | < 28 | 22.9 |
28–36 | 12.9 | |||
Lamarche-Vadel [73] | 1997 | 9 months | 24–25 | 53.2 |
26 | 46.7 | |||
27 | 46.1 | |||
28 | 46.8 | |||
Stephens [27] | 2001–2011 | 1 year | 24–27 | 62.1 |
28–31 | 47.7 | |||
32–33 | 36.2 |
Table 3
Impact of complications of preterm birth on readmission rates
Author | Years studied | Readmission time period | BPD odds ratio | Other factor odds ratio |
---|---|---|---|---|
Lorch [3] | 1998–2001 | 1 year | 2.2 | |
Smith [70] | 1995–1999 | 1 year
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