Outcomes Do Not Stop at Discharge: Post-NICU Health Care Use by Prematurely Born Infants


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 [1526]. 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


aRR 4.4



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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Jun 26, 2017 | Posted by in RESPIRATORY | Comments Off on Outcomes Do Not Stop at Discharge: Post-NICU Health Care Use by Prematurely Born Infants
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