Rehospitalization of extremely-low-birth-weight infants in first 2 years of life
Introduction
The survival of extremely-low-birth-weight (ELBW) infants (body weight at birth <1001 g) increased in 1990s [1]. Our previous study found an ELBW infant survival rate of 60% [2]. Chronic lung disease (CLD) is still a significant cause of mortality, morbidity, and prolonged hospitalization in ELBW infants [1]. Treatment with surfactant increases survival rates but does not lower the risk of CLD, and it appears unlikely that the frequency of CLD will decrease in the near future [3], [4], [5], [6].
Rehospitalization is a recognized and well-studied measure of the extended morbidity associated with the increased survival of very-low-birth-weight (VLBW; body weight at birth<1501 g) as well as ELBW infants [7], [8], [9], [10]. ELBW infants with CLD are at special risk of repeated hospitalization after their initial neonatal stay; previous reports showed rehospitalization rates in ELBW infants vary from 22% to 56% at 1 year of age and from 37% to 69% by 2 years of age [8], [9]. Efforts to identify the predictors of frequent rehospitalization have met with mixed results. The causes of these readmissions are multiple, but approximately two thirds of readmissions are for respiratory system problems such as pneumonia, respiratory syncytial virus (RSV), lower respiratory tract disease, or reactive airways [11]. VLBW infants with CLD have diminished pulmonary reserve, and prematurity itself may alter the long-term development of the lung whether or not the child has experienced respiratory distress syndrome (RDS) [11]. A previous study found that VLBW infants were readmitted due to respiratory illness in 11–33% of cases, even when CLD was not present [9], [11]. Infants who require oxygen at discharge are at high risk for readmission, and multiple admissions for individual infants are common [12]. However, there is little data on the incidence of readmission in ELBW infants since the era of surfactant use began. Several reports indicate that CLD has become less severe over the past years, probably in part because of the use of surfactants [13].
We reviewed the outcomes of ELBW infants admitted to the neonatal intensive care unit of National Taiwan University Hospital over a 5-year period when surfactant use was available. The incidence of CLD in ELBW infants, the incidence of hospitalization for ELBW infants with and without CLD, the duration of home oxygen therapy (HOT), and morbidity of these patients is described. To the best of our knowledge, this is the first study examining the rehospitalization rate and respiratory condition of ELBW infants in the surfactant therapy and other advanced therapy era.
Section snippets
Materials and methods
The charts of ELBW infants who were inborn and required intensive care at National Taiwan University Hospital from January 1993 to February 1998 were reviewed. Infants with major anomalies incompatible with survival and those whose parents refused resuscitation were excluded. Infants who had respiratory distress at birth, compatible radiography changes, and required supplemental oxygen at 36 weeks postmenstrual age (PMA) were considered to have CLD [14]. Infants breathing room air at 36 weeks
Results
During the 5-year study period, 106 ELBW infants were born in NTUH (the incidence was 6 in 1000 live births). Among them, 60 ELBW infants were discharged from NTUH. The survival rate was 61.2% (60/98). Eight cases were excluded from the analysis (five infants were not resuscitated because of parents' wishes, one had antenatally detected transposition of great arteries, one had deLange syndrome, phocomelia and cleft palate, and one was transferred to another hospital 2 days after birth). CLD
Discussion
Our data indicate that ELBW infants with CLD had an earlier gestational age, lower birth body weight, and more severe medical complications. Because the rate of birth of immature infants is expected to continue increasing, preventing morbidity due to CLD is becoming increasingly important [1]. The incidence of CLD was still high (42%) in this study even with current technical and therapeutic advances, including antenatal steroids, routine cranial ultrasonography, dexamethasone therapy for CLD,
References (19)
- et al.
Outcomes of children of extremely low birthweight and gestational age in the 1990s
Semin. Neonatol.
(2000) - et al.
Outcomes of children of extremely low birthweight and gestational age in the 1990's
Early Hum. Dev.
(1999) - et al.
Hospitalization as a measure of morbidity among very low birth weight infants with chronic lung disease
J. Pediatr.
(1996) - et al.
Continuing morbidity in extremely low birthweight infants
Early Hum. Dev.
(1988) - et al.
Improving health status in extremely low birthweight children between two and five years
Early Hum. Dev.
(1992) - et al.
Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 gm
J. Pediatr.
(1978) Growth and respiratory health in adolescence of the extremely low-birth weight survivor
Clin. Perinatol.
(2000)- et al.
The extremely-low-birth-weight infant
- et al.
Early outcome of extremely low birth weight infants in Taiwan
J. Formosan Med. Assoc.
(1998)
Cited by (42)
Long-Term Pulmonary Outcome of Preterm Infants
2018, The Newborn Lung: Neonatology Questions and Controversies, Third EditionImpact of a Transition Home Program on Rehospitalization Rates of Preterm Infants
2017, Journal of PediatricsCitation Excerpt :We analyzed rehospitalization rates for subgroups of early, moderate, and late PT infants. The inclusion of moderate and late PT infants is important because they represent the majority of PT infants, which means although their rate of rehospitalization may be lower, the prevalence and consequent economic burden are high.12,13,26,27 In our bivariable analysis, the rate of rehospitalization by 90 days was 12.8% in the early PT subgroup, 7.2% in the moderate PT subgroup, and 7.4% for the late PT subgroup.
Intensive care unit readmission during childhood after preterm birth with respiratory failure
2014, Journal of PediatricsHospital Readmissions and Repeat Emergency Department Visits Among Children With Medical Complexity: An Integrative Review
2013, Journal of Pediatric NursingCitation Excerpt :In contrast, few studies were conducted in either rural or community-based settings. Single centers included freestanding children's hospitals (Boyd & Hunsberger, 1998; Frei-Jones et al., 2009; Graf et al., 2008; Sutton et al., 2008; Yamamoto et al., 1995), hospitals caring for children and adults (Kelly & Hewson, 2000; Silva, Hagan, & Sly, 1995), and single-center neonatal intensive care units (NICUs) (Chang, Hsu, Kao, Hung, & Huang, 1998; Chien, Tsao, Chou, Tang, & Tsou, 2002; Furman, Baley, Borawski-Clark, Aucott, & Hack, 1996; Iles & Edmunds, 1996). Eight of the study reports described multicenter settings, in which the number of settings ranged from two NICUs serving a 17-county area (deRegnier, Roberts, Ramsey, Weaver, & O'Shea, 1997) to a database of over 30 children's hospitals (Berry et al., 2009; Berry et al., 2011; Feudtner et al., 2009).
Factors associated with rehospitalizations of very low birthweight infants: Impact of a transition home support and education program
2012, Early Human DevelopmentCitation Excerpt :The majority of rehospitalizations between discharge and 7 months CA occurred by 3 months CA (25/29 86% and 23/26 88%) during both Phase 1 and Phase 2. Although our findings are consistent with others that preterm infants are at increased risk of rehospitalization after discharge from the NICU, our rates during Phase 2 of 15% by 3 months and 17% by 7 months are lower than prior reports [9,22–24]. Data from the EPIPAGE cohort of infants < 29 weeks of gestation revealed that 178 (47%) of 376 were admitted at least once to the hospital between discharge and 9 months chronologic age [25].
Impact of very low birth weight infants on the family at 3months corrected age
2011, Early Human Development