Am J Perinatol 2016; 33(01): 024-033
DOI: 10.1055/s-0035-1555123
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Rehospitalization in Infants Born < 29 Weeks' Gestation during the First 2 Years of Life: Risk Assessment

Jane B. Taylor
1   Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
2   Department of Pediatrics, University of Kansas School of Medicine at the University of Kansas Medical Center, Kansas City, Kansas
,
Mitzi A. Go
2   Department of Pediatrics, University of Kansas School of Medicine at the University of Kansas Medical Center, Kansas City, Kansas
,
Michael F. Nyp
1   Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
,
Jennifer Legino
2   Department of Pediatrics, University of Kansas School of Medicine at the University of Kansas Medical Center, Kansas City, Kansas
,
Michael Norberg
1   Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
,
Hongying Dai
1   Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
3   Department of Research Development and Clinical Investigation, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
,
William E. Truog
1   Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
› Author Affiliations
Further Information

Publication History

12 March 2015

07 May 2015

Publication Date:
17 June 2015 (online)

Abstract

Objective This study aims to determine risk factors for rehospitalization in extremely premature infants.

Study Design A retrospective cohort study of 157 infants born < 29 weeks' gestational age assessing risk factors for rehospitalization through 2 years of life.

Results Multivariable logistic regression showed that an increasing number of respiratory infections (odds ratio [OR]: 1.8 [1.1–3.1] per infection p = 0.03) and inhaled steroid use at 1 year (OR: 4.0 [1.3–12.1] p = 0.01) were predictive of hospital readmission. Diuretic (OR: 27 [1.01–1,000] p = 0.04) and oxygen (OR: 32 [3.1–333] p = 0.004) use at 1 year were predictive of pediatric intensive care unit admission. The number of respiratory infections (OR: 2.8 [1.7–4.5] p < 0.0001) with reflux/aspiration necessitating G-tube/Nissen fundoplication surgical intervention with or without G-tubes alone (OR: 21.3 [2.9–166.7] p = 0.02 and OR: 22.7 [CI, 2.4–200] p = 0.04) was predictive of increased number of rehospitalizations.

Conclusions Key modifiable risk factors identified were reflux/aspiration and ongoing respiratory infections. Critical time periods for diuretic, oxygen, and inhaled steroid use in this population occurred at the age of 1 year.

 
  • References

  • 1 Groothuis JR, Makari D. Definition and outpatient management of the very low-birth-weight infant with bronchopulmonary dysplasia. Adv Ther 2012; 29 (4) 297-311
  • 2 Palm K, Simoneau T, Sawicki G, Rhein L. Assessment of current strategies for weaning premature infants from supplemental oxygen in the outpatient setting. Adv Neonatal Care 2011; 11 (5) 349-356
  • 3 Rhein LM, Konnikova L, McGeachey A, Pruchniewski M, Smith VC. The role of pulmonary follow-up in reducing health care utilization in infants with bronchopulmonary dysplasia. Clin Pediatr (Phila) 2012; 51 (7) 645-650
  • 4 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (7) 1723-1729
  • 5 Drysdale SB, Wilson T, Alcazar M , et al. Lung function prior to viral lower respiratory tract infections in prematurely born infants. Thorax 2011; 66 (6) 468-473
  • 6 Stoll BJ, Hansen NI, Bell EF , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (3) 443-456
  • 7 Anand D, Stevenson CJ, West CR, Pharoah PO. Lung function and respiratory health in adolescents of very low birth weight. Arch Dis Child 2003; 88 (2) 135-138
  • 8 Taylor JB, Nyp MF, Norberg M , et al. Impact of intercurrent respiratory infections on lung health in infants born <29 weeks with bronchopulmonary dysplasia. J Perinatol 2014; 34 (3) 223-228
  • 9 Bennett NJ, Tabarani CM, Bartholoma NM , et al. Unrecognized viral respiratory tract infections in premature infants during their birth hospitalization: a prospective surveillance study in two neonatal intensive care units. J Pediatr 2012; 161 (5) 814-818
  • 10 Jartti T, Lee W-M, Pappas T, Evans M, Lemanske Jr RF, Gern JE. Serial viral infections in infants with recurrent respiratory illnesses. Eur Respir J 2008; 32 (2) 314-320
  • 11 Greenough A, Cox S, Alexander J , et al. Health care utilisation of infants with chronic lung disease, related to hospitalisation for RSV infection. Arch Dis Child 2001; 85 (6) 463-468
  • 12 Blencowe H, Cousens S, Oestergaard MZ , et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012; 379 (9832) 2162-2172
  • 13 Fakhoury KF, Sellers C, Smith EO, Rama JA, Fan LL. Serial measurements of lung function in a cohort of young children with bronchopulmonary dysplasia. Pediatrics 2010; 125 (6) e1441-e1447
  • 14 Doyle LW, Faber B, Callanan C, Freezer N, Ford GW, Davis NM. Bronchopulmonary dysplasia in very low birth weight subjects and lung function in late adolescence. Pediatrics 2006; 118 (1) 108-113
  • 15 Vrijlandt EJ, Gerritsen J, Boezen HM, Grevink RG, Duiverman EJ. Lung function and exercise capacity in young adults born prematurely. Am J Respir Crit Care Med 2006; 173 (8) 890-896
  • 16 Moster D, Lie RT, Markestad T. Long-term medical and social consequences of preterm birth. N Engl J Med 2008; 359 (3) 262-273
  • 17 Lum S, Kirkby J, Welsh L, Marlow N, Hennessy E, Stocks J. Nature and severity of lung function abnormalities in extremely pre-term children at 11 years of age. Eur Respir J 2011; 37 (5) 1199-1207
  • 18 Cazzato S, Ridolfi L, Bernardi F, Faldella G, Bertelli L. Lung function outcome at school age in very low birth weight children. Pediatr Pulmonol 2013; 48 (8) 830-837
  • 19 Mahut B, De Blic J, Emond S , et al. Chest computed tomography findings in bronchopulmonary dysplasia and correlation with lung function. Arch Dis Child Fetal Neonatal Ed 2007; 92 (6) F459-F464
  • 20 Linder JE, Kraft DC, Mohamed Y , et al. Human rhinovirus C: Age, season, and lower respiratory illness over the past 3 decades. J Allergy Clin Immunol 2013; 131 (1) 69-77.e1 , 6
  • 21 Truog WE, Nyp MF, Taylor J , et al. Infants born at <29 weeks: pulmonary outcomes from a hybrid perinatal system. J Perinatol 2014; 34 (1) 59-63
  • 22 Laughon MM, Langer JC, Bose CL , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Prediction of bronchopulmonary dysplasia by postnatal age in extremely premature infants. Am J Respir Crit Care Med 2011; 183 (12) 1715-1722
  • 23 Ehrenkranz RA, Walsh MC, Vohr BR , et al; National Institutes of Child Health and Human Development Neonatal Research Network. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005; 116 (6) 1353-1360
  • 24 Owens P, Thompson J, Elixhauser A, Ryan K. Care of Children and Adolescents in US Hospitals. Rockville, MD: Agency for Healthcare Research and Quality; 2003. . HCUP Fact Book No 4
  • 25 McLaurin KK, Hall CB, Jackson EA, Owens OV, Mahadevia PJ. Persistence of morbidity and cost differences between late-preterm and term infants during the first year of life. Pediatrics 2009; 123 (2) 653-659
  • 26 Mally PV, Bailey S, Hendricks-Muñoz KD. Clinical issues in the management of late preterm infants. Curr Probl Pediatr Adolesc Health Care 2010; 40 (9) 218-233
  • 27 Balinotti JE, Chakr VC, Tiller C , et al. Growth of lung parenchyma in infants and toddlers with chronic lung disease of infancy. Am J Respir Crit Care Med 2010; 181 (10) 1093-1097
  • 28 Greenough A. Long term respiratory outcomes of very premature birth (<32 weeks). Semin Fetal Neonatal Med 2012; 17 (2) 73-76