Rehospitalization of extremely-low-birth-weight infants in first 2 years of life

https://doi.org/10.1016/S0378-3782(01)00233-XGet rights and content

Abstract

Aims: To determine whether (1) chronic lung disease (CLD) is the prime reason for extremely-low-birth-weight (ELBW) infant readmission during the first 2 years of life, (2) surfactant and other advanced therapies have reduced ELBW infant readmissions, (3) home oxygen therapy (HOT) is efficacious for this group. Study design: The hospital records of these ELBW infants were reviewed retrospectively. Data on age, diagnosis, treatment, and duration of each hospitalization were compiled and analyzed for their association to CLD and to readmission for CLD and other reasons. Subjects: All 60 surviving infants with a birth body weight of less than 1001 g (ELBW) born from January 1993 to February 1998 were followed up to 2 years (mean 20.4±7.4 months) to evaluate their respiratory outcome. Results: Forty-two percent of these infants developed CLD. Upon discharge from the hospital, 28% (7/25) of the patients were given HOT for a median period of 60 days. Of the 47 ELBW infants who were studied the entire 2-year period, 72% were readmitted. Infants with CLD were readmitted more frequently (p=0.045) and had longer hospital stays during the first 2 years of life (p=0.034) than those without CLD. Respiratory illness was the main reason for readmission (55%) of these ELBW infants. The incidence of readmission due to respiratory tract infection was not significantly different in infants with CLD (61%) and infants without respiratory complications (44%) (p=0.159). Conclusions: Infants with CLD (whether receiving HOT or not) showed no higher readmission rate due to respiratory infection, but the HOT group did have higher morbidity. The premature lung itself rather than the presence of CLD, as we would expect, makes ELBW infants more prone to readmission for respiratory illness.

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)

There are more references available in the full text version of this article.

Cited by (42)

  • Long-Term Pulmonary Outcome of Preterm Infants

    2018, The Newborn Lung: Neonatology Questions and Controversies, Third Edition
  • Impact of a Transition Home Program on Rehospitalization Rates of Preterm Infants

    2017, Journal of Pediatrics
    Citation 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.

  • Hospital Readmissions and Repeat Emergency Department Visits Among Children With Medical Complexity: An Integrative Review

    2013, Journal of Pediatric Nursing
    Citation 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 Development
    Citation 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].

View all citing articles on Scopus
View full text