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Am J Perinatol 2021; 38(S 01): e330-e337
DOI: 10.1055/s-0040-1710011
Original Article

Does Duration Off Respiratory Support Prior to Discharge from NICU Predict Hospital Readmission among Extremely Low Gestational Age Neonates?

Priyam Pattnaik
1   Department of Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
,
Samantha Palmaccio
1   Department of Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
,
Judy Aschner
1   Department of Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
2   Department of Pediatrics, Hackensack Meridian School of Medicine at Seton Hall, Nutley, New Jersey
,
Ruth Eisenberg
3   Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
,
Jaeun Choi
3   Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
,
M. Susan LaTuga
1   Department of Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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Abstract

Objective Our objective was to determine if the duration off respiratory support prior to discharge home from the neonatal intensive care unit (NICU) would impact hospital readmission rates among extremely low gestational age neonates (ELGAN).

Study Design In this retrospective chart review, we examined readmission rates for ELGAN admitted to the Montefiore–Weiler NICU between 2013 and 2015.

Results Of 140 infants born at <29 weeks' gestational age, 30 (21%) of these infants were subsequently readmitted within 90 days, primarily for respiratory complaints. Readmitted infants were born at an earlier gestational age (median = 26 weeks; interquartile range [IQR]: 24–27 weeks) compared to infants who did not require readmission (median = 27 weeks; IQR: 25-28 weeks), p = 0.03. Birth weights were smaller among infants who required readmission, 800 ± 248 g compared to 910 ± 214 g (p = 0.02). Infants with Hispanic ethnicity and those discharged during the spring season were likely to be readmitted. Duration off respiratory support prior to discharge did not predict 90-day readmission rates. Lower gestational age and birth weight were associated with higher rates of readmissions after NICU discharge.

Conclusion Duration off and invasiveness of respiratory support prior to discharge did not predict risk of 90-day readmission nor did discharge during months with traditionally higher prevalence of respiratory viruses.

Keywords

extremely low gestational age neonate - NICU discharge - hospital readmission - respiratory support - bronchopulmonary dysplasia


Publikationsverlauf

Eingereicht: 22. August 2019

Angenommen: 24. März 2020

Artikel online veröffentlicht:
05. Mai 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Jarjour IT. Neurodevelopmental outcome after extreme prematurity: a review of the literature. Pediatr Neurol 2015; 52 (02) 143-152
    CrossrefPubMedGoogle Scholar
  • 2 Russell RB, Green NS, Steiner CA. et al. Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics 2007; 120 (01) e1-e9
    CrossrefPubMedGoogle Scholar
  • 3 Schmitt SK, Sneed L, Phibbs CS. Costs of newborn care in California: a population-based study. Pediatrics 2006; 117 (01) 154-160
    CrossrefPubMedGoogle Scholar
  • 4 McCormick MC, Shapiro S, Starfield BH. Rehospitalization in the first year of life for high-risk survivors. Pediatrics 1980; 66 (06) 991-999
    PubMedGoogle Scholar
  • 5 van Zeben-van der Aa DM, Verloove-Vanhorick SP, Brand R, Ruys JH. The use of health services in the first 2 years of life in a nationwide cohort of very preterm and/or very low birthweight infants in The Netherlands: rehospitalisation and out-patient care. Paediatr Perinat Epidemiol 1991; 5 (01) 11-26
    CrossrefPubMedGoogle Scholar
  • 6 Elisabeth R, Elke G, Vera N, Maria G, Michaela H, Ursula KK. Readmission of preterm infants less than 32 weeks gestation into early childhood: does gender difference still play a role?. Glob Pediatr Health 2014; 1: 2333794X14549621
    PubMedGoogle Scholar
  • 7 Elder DE, Hagan R, Evans SF, Benninger HR, French NP. Hospital admissions in the first year of life in very preterm infants. J Paediatr Child Health 1999; 35 (02) 145-150
    CrossrefPubMedGoogle Scholar
  • 8 Hack M, DeMonterice D, Merkatz IR, Jones P, Fanaroff AA. Rehospitalization of the very-low-birth-weight infant. A continuum of perinatal and environmental morbidity. Am J Dis Child 1981; 135 (03) 263-266
    CrossrefPubMedGoogle Scholar
  • 9 Furman L, Borawski-Clark E, Aucott S, Hack M. Hospitalization as a measure of morbidity among very low birth weight infants with chronic lung disease. J Pedistr 1996; 128 (04) 447-452
    CrossrefPubMedGoogle Scholar
  • 10 Morris BH, Gard CC, Kennedy K. ; NICHD Neonatal Research Network. Rehospitalization of extremely low birth weight (ELBW) infants: are there racial/ethnic disparities?. J Perinatol 2005; 25 (10) 656-663
    CrossrefPubMedGoogle Scholar
  • 11 Lorch SA, Baiocchi M, Silber JH, et al. The role of outpatient facilities in explaining variations in risk-adjusted readmission rates between hospitals. HSR 2010;45(1):24–41
  • 12 Ambalavanan N, Carlo WA, McDonald SA, Yao Q, Das A, Higgins RD. ; Generic Database and Follow-up Subcommittees of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Identification of extremely premature infants at high risk of rehospitalization. Pediatrics 2011; 128 (05) e1216-e1225
    CrossrefPubMedGoogle Scholar
  • 13 Lamarche-Vadel A, Blondel B, Truffer P. et al; EPIPAGE Study Group. Re-hospitalization in infants younger than 29 weeks' gestation in the EPIPAGE cohort. Acta Paediatr 2004; 93 (10) 1340-1345
    CrossrefPubMedGoogle Scholar
  • 14 Ambalavanan N, Morty RE. Searching for better animal models of BPD: a perspective. Am J Physiol Lung Cell Mol Physiol 2016; 311 (05) L924-L927
    CrossrefPubMedGoogle Scholar
  • 15 Bell MJ, Ternberg JL, Feigin RD. et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 16 Volpe JJ. Intraventricular hemorrhage in the premature infant--current concepts. Part I. Ann Neurol 1989; 25 (01) 3-11
    CrossrefPubMedGoogle Scholar
  • 17 Fenton TR. A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr 2003; 3: 13
    CrossrefPubMedGoogle Scholar
  • 18 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
    CrossrefPubMedGoogle Scholar
  • 19 Chandrasekharan P, Rawat M, Reynolds AM, Phillips K, Lakshminrusimha S. Apnea, bradycardia and desaturation spells in premature infants: impact of a protocol for the duration of ‘spell-free’ observation on interprovider variability and readmission rates. J Perinatol 2018; 38 (01) 86-91
    CrossrefPubMedGoogle Scholar
  • 20 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
    CrossrefPubMedGoogle Scholar
  • 21 Mourani PM, Kinsella JP, Clermont G. et al; Prolonged Outcomes after Nitric Oxide (PrONOx) Investigators. Intensive care unit readmission during childhood after preterm birth with respiratory failure. J Pediatr 2014; 164 (04) 749-755.e3
    CrossrefPubMedGoogle Scholar
  • 22 Carbonell-Estrany X, Quero J, Bustos G. et al; IRIS Study Group. Rehospitalization because of respiratory syncytial virus infection in premature infants younger than 33 weeks of gestation: a prospective study. Pediatr Infect Dis J 2000; 19 (07) 592-597
    CrossrefPubMedGoogle Scholar
  • 23 Eriksson M, Bennet R, Rotzén-Ostlund M, von Sydow M, Wirgart BZ. Population-based rates of severe respiratory syncytial virus infection in children with and without risk factors, and outcome in a tertiary care setting. Acta Paediatr 2002; 91 (05) 593-598
    CrossrefPubMedGoogle Scholar
  • 24 Joffe S, Escobar GJ, Black SB, Armstrong MA, Lieu TA. Rehospitalization for respiratory syncytial virus among premature infants. Pediatrics 1999; 104 (4 Pt 1): 894-899
    CrossrefPubMedGoogle Scholar
  • 25 Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. The IMpact-RSV Study Group. Pediatrics 1998; 102 (3 Pt 1): 531-537
    CrossrefPubMedGoogle Scholar
  • 26 American Academy of Pediatrics Committee on Infectious Diseases; American Academy of Pediatrics Bronchiolitis Guidelines Committee. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics 2014; 134 (02) e620-e638
    CrossrefPubMedGoogle Scholar
  • 27 Vohr BR, Poindexter BB, Dusick AM. et al; NICHD Neonatal Research Network. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics 2006; 118 (01) e115-e123
    CrossrefPubMedGoogle Scholar
  • 28 Vohr BR, Poindexter BB, Dusick AM. et al; National Institute of Child Health and Human Development National Research Network. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics 2007; 120 (04) e953-e959
    CrossrefPubMedGoogle Scholar