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

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Part of the Respiratory Medicine book series (RM)

Abstract

The health care needs of prematurely born infants do not stop upon discharge from the neonatal intensive care unit (NICU). Costs and resource utilization by preterm, low birth weight infants (those at the highest risk of readmission) are substantially higher than infants born at term, with an estimated 35 % of all health care costs in the first year of life stemming from the care of the infants born at a birth weight <1500 g. However, there are limited data to help counsel families about the health care use of their prematurely born infant after the child is discharged from the NICU, and how these expectations may change based on the child’s medical conditions and the family’s social and economic factors. This chapter will present a summary of the postdischarge health care use of prematurely born infants, including future hospitalizations, emergency department visits, and outpatient health care use including medications and nonwell visits. Each section will present information on the prevalence of each outcome and risk factors for differences in rates based on specific medical risk factors. Finally, we will end with a conceptual framework for increased health care use in these infants and directions for future research in the field.

Keywords

  • Readmission (or Hospitalization)
  • Very low birth weight infant
  • Bronchopulmonary dysplasia
  • Emergency department visits
  • Social determinants of health
  • Medication use

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References

  1. Gilbert WM, Nesbitt TS, Danielsen B. The cost of prematurity: quantification by gestational age and birth weight. Obstet Gynecol. 2003;102(3):488–92.

    PubMed  Google 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(1):e1–9.

    CrossRef  PubMed  Google Scholar 

  3. Lorch SA, Baiocchi M, Silber JH, et al. The role of outpatient facilities in explaining variations in risk-adjusted readmission rates between hospitals. Health Serv Res. 2010;45(1):24–41.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  4. Tsai TC, Joynt KE, Orav EJ, et al. Variation in surgical-readmission rates and quality of hospital care. N Engl J Med. 2013;369(12):1134–42.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  5. Berry JG, Toomey SL, Zaslavsky AM, et al. Pediatric readmission prevalence and variability across hospitals. JAMA. 2013;309(4):372–80.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  6. Morse RB, Hall M, Fieldston ES, et al. Hospital-level compliance with asthma care quality measures at children’s hospitals and subsequent asthma-related outcomes. JAMA. 2011;306(13):1454–60.

    CAS  CrossRef  PubMed  Google Scholar 

  7. Escobar GJ, Greene JD, Hulac P, et al. Rehospitalisation after birth hospitalisation: Patterns among infants of all gestations. Arch Dis Child. 2005;90(2):125–31.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  8. Profit J, McCormick MC, Escobar GJ, et al. Neonatal intensive care unit census influences discharge of moderately preterm infants. Pediatrics. 2007;119(2):314–9.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  9. Seki K, Iwasaki S, An H, et al. Early discharge from a neonatal intensive care unit and rates of readmission. Pediatr Int. 2011;53(1):7–12.

    CrossRef  PubMed  Google Scholar 

  10. Kotagal UR, Perlstein PH, Gamblian V, et al. Description and evaluation of a program for the early discharge of infants from a neonatal intensive care unit. J Pediatr. 1995;127(2):285–90.

    CAS  CrossRef  PubMed  Google Scholar 

  11. Paul IM, Lehman EB, Hollenbeak CS, et al. Preventable newborn readmissions since passage of the Newborns’ and Mothers’ Health Protection Act. Pediatrics. 2006;118(6):2349–58.

    CrossRef  PubMed  Google Scholar 

  12. Doering LV, Moser DK, Dracup K. Correlates of anxiety, hostility, depression, and psychosocial adjustment in parents of NICU infants. Neonatal Netw. 2000;19(5):15–23.

    CAS  CrossRef  PubMed  Google Scholar 

  13. Carter JD, Mulder RT, Bartram AF, et al. Infants in a neonatal intensive care unit: parental response. Arch Dis Child Fetal Neonatal Ed. 2005;90(2):F109–13.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  14. Bakewell-Sachs S, Gennaro S. Parenting the post-NICU premature infant. MCN Am J Matern Child Nurs. 2004;29(6):398–403.

    CrossRef  PubMed  Google Scholar 

  15. Doyle LW, Ford G, Davis N. Health and hospitalistions after discharge in extremely low birth weight infants. Semin Neonatol. 2003;8(2):137–45.

    CrossRef  PubMed  Google Scholar 

  16. Chien YH, Tsao PN, Chou HC, et al. Rehospitalization of extremely-low-birth-weight infants in first 2 years of life. Early Hum Dev. 2002;66(1):33–40.

    CrossRef  PubMed  Google Scholar 

  17. Furman L, Baley J, Borawski-Clark E, et al. Hospitalization as a measure of morbidity among very low birth weight infants with chronic lung disease. J Pediatr. 1996;128(4):447–52.

    CAS  CrossRef  PubMed  Google Scholar 

  18. Kuzniewicz MW, Parker SJ, Schnake-Mahl A, et al. Hospital readmissions and emergency department visits in moderate preterm, late preterm, and early term infants. Clin Perinatol. 2013;40(4):753–75.

    CrossRef  PubMed  Google Scholar 

  19. McLaurin KK, Hall CB, Jackson EA, et al. Persistence of morbidity and cost differences between late-preterm and term infants during the first year of life. Pediatrics. 2009;123(2):653–9.

    CrossRef  PubMed  Google Scholar 

  20. Ray KN, SA L. Hospitalization of early preterm, late preterm, and term infants during the first year of life by gestational age. Hospital Pediatrics. 2013;3(3):194–203.

    CrossRef  PubMed  Google Scholar 

  21. Morris BH, Gard CC, Kennedy K. Rehospitalization of extremely low birth weight (ELBW) infants: are there racial/ethnic disparities? J Perinatol. 2005;25(10):656–63.

    CrossRef  PubMed  Google Scholar 

  22. Escobar GJ, Joffe S, Gardner MN, et al. Rehospitalization in the first two weeks after discharge from the neonatal intensive care unit. Pediatrics. 1999;104(1):e2.

    CAS  CrossRef  PubMed  Google Scholar 

  23. Martens PJ, Derksen S, Gupta S. Predictors of hospital readmission of Manitoba newborns within six weeks postbirth discharge: a population-based study. Pediatrics. 2004;114(3):708–13.

    CrossRef  PubMed  Google Scholar 

  24. Ambalavanan N, Carlo WA, McDonald SA, et al. Identification of extremely premature infants at high risk of rehospitalization. Pediatrics. 2011;128(5):e1216–25.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  25. Young PC, Korgenski K, Buchi KF. Early readmission of newborns in a large health care system. Pediatrics. 2013;131(5):e1538–44.

    CrossRef  PubMed  Google Scholar 

  26. Elder DE, Hagan R, Evans SF, et al. Hospital admissions in the first year of life in very preterm infants. J Paediatr Child Health. 1999;35(2):145–50.

    CAS  CrossRef  PubMed  Google Scholar 

  27. Stephens AS, Lain SJ, Roberts CL, et al. Survival, hospitalization, and acute-care costs of very and moderate preterm infants in the first 6 years of life: a population-based study. J Pediatr. 2016;169:61–8. e63

    CrossRef  PubMed  Google Scholar 

  28. Hall CB, Weinberg GA, Iwane MK, et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med. 2009;360(6):588–98.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  29. Hall CB, Weinberg GA, Blumkin AK, et al. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics. 2013;132(2):e341–8.

    CrossRef  PubMed  Google Scholar 

  30. Munoz-Quiles C, Lopez-Lacort M, Ubeda-Sansano I, et al. Population-based analysis of bronchiolitis epidemiology in Valencia, Spain. Pediatr Infect Dis J. 2016;35(3):275–80.

    CrossRef  PubMed  Google Scholar 

  31. Fjaerli HO, Farstad T, Bratlid D. Hospitalisations for respiratory syncytial virus bronchiolitis in Akershus, Norway, 1993-2000: a population-based retrospective study. BMC Pediatr. 2004;4(1):25.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  32. Figueras-Aloy J, Carbonell-Estrany X, Quero-Jimenez J, et al. FLIP-2 Study: risk factors linked to respiratory syncytial virus infection requiring hospitalization in premature infants born in Spain at a gestational age of 32 to 35 weeks. Pediatr Infect Dis J. 2008;27(9):788–93.

    CrossRef  PubMed  Google Scholar 

  33. Boyce TG, Mellen BG, Mitchel Jr EF, et al. Rates of hospitalization for respiratory syncytial virus infection among children in medicaid. J Pediatr. 2000;137(6):865–70.

    CAS  CrossRef  PubMed  Google Scholar 

  34. Helfrich AM, Nylund CM, Eberly MD, et al. Healthy late-preterm infants born 33-36+6 weeks gestational age have higher risk for respiratory syncytial virus hospitalization. Early Hum Dev. 2015;91(9):541–6.

    CrossRef  PubMed  Google Scholar 

  35. Forbes ML, Hall CB, Jackson A, et al. Comparative costs of hospitalisation among infants at high risk for respiratory syncytial virus lower respiratory tract infection during the first year of life. J Med Econ. 2010;13(1):136–41.

    CrossRef  PubMed  Google Scholar 

  36. Horn SD, Smout RJ. Effect of prematurity on respiratory syncytial virus hospital resource use and outcomes. J Pediatr. 2003;143(5 Suppl):S133–41.

    CrossRef  PubMed  Google Scholar 

  37. Greenberg D, Dagan R, Shany E, et al. Increased risk for respiratory syncytial virus-associated, community-acquired alveolar pneumonia in infants born at 31-36 weeks of gestation. Pediatr Infect Dis J. 2014;33(4):381–6.

    CrossRef  PubMed  Google Scholar 

  38. Greenough A, Alexander J, Burgess S, et al. Health care utilisation of prematurely born, preschool children related to hospitalisation for RSV infection. Arch Dis Child. 2004;89(7):673–8.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  39. Lee JH, Chang YS, Committee on Data C, et al. Use of medical resources by preterm infants born at less than 33 weeks’ gestation following discharge from the Neonatal Intensive Care Unit in Korea. J Korean Med Sci. 2015;30(Suppl 1):S95–S103.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  40. Jain S, Cheng J. Emergency department visits and rehospitalizations in late preterm infants. Clin Perinatol. 2006;33(4):935–45. abstract xi.

    CrossRef  PubMed  Google Scholar 

  41. Goyal NK, Folger AT, Hall ES, et al. Effects of home visiting and maternal mental health on use of the emergency department among late preterm infants. J Obstet Gynecol Neonatal Nurs. 2015;44(1):135–44.

    CrossRef  PubMed  Google Scholar 

  42. Ray K, Escobar GJ, Lorch SA. Premature infants born to adolescent mothers: Health care utilization after initial discharge academic pediatrics. Acad Pediatr. 2010;10(5):302–8.

    CrossRef  PubMed  Google Scholar 

  43. McGrath-Morrow SA, Lee G, Stewart BH, et al. Day care increases the risk of respiratory morbidity in chronic lung disease of prematurity. Pediatrics. 2010;126(4):632–7.

    CrossRef  PubMed  Google Scholar 

  44. Rhein LM, Konnikova L, McGeachey A, et al. The role of pulmonary follow-up in reducing health care utilization in infants with bronchopulmonary dysplasia. Clin Pediatr (Phila). 2012;51(7):645–50.

    CrossRef  Google Scholar 

  45. Wade KC, Lorch SA, Bakewell-Sachs S, et al. Pediatric care for preterm infants after NICU discharge: High number of office visits and prescription medications. J Perinatol. 2008;28(10):696–701.

    CAS  CrossRef  PubMed  Google Scholar 

  46. Luu TM, Lefebvre F, Riley P, et al. Continuing utilisation of specialised health services in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed. 2010;95(5):F320–5.

    CAS  CrossRef  PubMed  Google Scholar 

  47. Gray D, Woodward LJ, Spencer C, et al. Health service utilisation of a regional cohort of very preterm infants over the first 2 years of life. J Paediatr Child Health. 2006;42(6):377–83.

    CrossRef  PubMed  Google Scholar 

  48. Nakamura MM, Toomey SL, Zaslavsky AM, et al. Measuring pediatric hospital readmission rates to drive quality improvement. Acad Pediatr. 2014;14(5 Suppl):S39–46.

    CrossRef  PubMed  Google Scholar 

  49. Lorch SA, Passarella M, Zeigler A. Challenges to measuring variation in readmission rates of neonatal intensive care patients. Acad Pediatr. 2014;14(5 Suppl):S47–53.

    CrossRef  PubMed  Google Scholar 

  50. Coller RJ, Nelson BB, Sklansky DJ, et al. Preventing hospitalizations in children with medical complexity: a systematic review. Pediatrics. 2014;134(6):e1628–47.

    CrossRef  PubMed  Google Scholar 

  51. Herrin J, St Andre J, Kenward K, et al. Community factors and hospital readmission rates. Health Serv Res. 2015;50(1):20–39.

    CrossRef  PubMed  Google Scholar 

  52. McMillan JE, Meier ER, Winer JC, et al. Clinical and geographic characterization of 30-day readmissions in pediatric Sickle Cell crisis patients. Hosp Pediatr. 2015;5(8):423–31.

    CrossRef  PubMed  Google Scholar 

  53. Lorch SA. Quality measurements in pediatrics: What do they assess? JAMA Pediatr. 2013;167(1):89–90.

    CrossRef  PubMed  Google Scholar 

  54. Krumholz HM, Lin Z, Keenan PS, et al. Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia. JAMA. 2013;309(6):587–93.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  55. Silber JH, Lorch SA, Rosenbaum PR, et al. Time to send the preemie home? Additional maturity at discharge and subsequent healthcare costs and outcomes. Health Serv Res. 2009;44(2, Part I):444–463.

    Google Scholar 

  56. Srivastava R, Keren R. Pediatric readmissions as a hospital quality measure. JAMA. 2013;309(4):396–8.

    CAS  CrossRef  PubMed  Google Scholar 

  57. Hoehn RS, Wima K, Vestal MA, et al. Effect of hospital safety-net burden on cost and outcomes after surgery. JAMA Surg. 2016;151(2):120–8.

    CrossRef  PubMed  Google Scholar 

  58. Joynt K, Jha AK. Which hospitals have higher readmission rates for patients with heart failure? J Am Coll Cardiol. 2010;55(10s1):A143.E1348.

    Google Scholar 

  59. Beck AF, Simmons JM, Huang B, et al. Geomedicine: Area-based socioeconomic measures for assessing risk of hospital reutilization among children admitted for asthma. Am J Public Health. 2012;102(12):2308–14.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  60. Liu SY, Pearlman DN. Hospital readmissions for childhood asthma: The role of individual and neighborhood factors. Public Health Rep. 2009;124(1):65–78.

    PubMed  PubMed Central  Google Scholar 

  61. Ray KN, Lorch SA. Hospitalization of rural and urban infants during the first year of life. Pediatrics. 2012;130(6):1084–93.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  62. Rice-Townsend S, Hall M, Barnes JN, et al. Variation in risk-adjusted hospital readmission after treatment of appendicitis at 38 children’s hospitals: An opportunity for collaborative quality improvement. Ann Surg. 2013;257(4):758–65.

    CrossRef  PubMed  Google Scholar 

  63. Auger KA, Kahn RS, Davis MM, et al. Medical home quality and readmission risk for children hospitalized with asthma exacerbations. Pediatrics. 2013;131(1):64–70.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  64. Bloomberg GR, Trinkaus KM, Fisher Jr EB, et al. Hospital readmissions for childhood asthma: A 10-year metropolitan study. Am J Respir Crit Care Med. 2003;167(8):1068–76.

    CrossRef  PubMed  Google Scholar 

  65. Coller RJ, Klitzner TS, Lerner CF, et al. Predictors of 30-day readmission and association with primary care follow-up plans. J Pediatr. 2013;163(4):1027–33.

    CrossRef  PubMed  Google Scholar 

  66. McGregor MJ, Reid RJ, Schulzer M, et al. Socioeconomic status and hospital utilization among younger adult pneumonia admissions at a Canadian hospital. BMC Health Serv Res. 2006;6:152.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  67. Lorch SA, Enlow E. The role of social determinants in explaining racial/ethnic disparities in perinatal outcomes. Pediatr Res. 2016;79(1–2):141–7. doi:10.1038/pr.2015.199. Epub 2015 Oct 14.

    CrossRef  PubMed  Google Scholar 

  68. Goyal N, Zubizarreta JR, Small DS, et al. Length of stay and readmissions among late preterm infants: an instrumental variable approach. Hosp Pediatr. 2013;3(1):7–15.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  69. Moyer LB, Goyal NK, Meinzen-Derr J, et al. Factors associated with readmission in late-preterm infants: a matched case-control study. Hosp Pediatr. 2014;4(5):298–304.

    CrossRef  PubMed  Google Scholar 

  70. Smith VC, Zupancic JA, McCormick MC, et al. Rehospitalization in the first year of life among infants with bronchopulmonary dysplasia. J Pediatr. 2004;144(6):799–803.

    PubMed  Google Scholar 

  71. Slimings C, Einarsdottir K, Srinivasjois R, et al. Hospital admissions and gestational age at birth: 18 years of follow up in Western Australia. Paediatr Perinat Epidemiol. 2014;28(6):536–44.

    CrossRef  PubMed  Google Scholar 

  72. Tseng YH, Chen CW, Huang HL, et al. Incidence of and predictors for short-term readmission among preterm low-birthweight infants. Pediatr Int. 2010;52(5):711–7.

    CrossRef  PubMed  Google Scholar 

  73. Lamarche-Vadel A, Blondel B, Truffer P, et al. Re-hospitalization in infants younger than 29 weeks’ gestation in the EPIPAGE cohort. Acta Paediatr. 2004;93(10):1340–5.

    CAS  CrossRef  PubMed  Google Scholar 

  74. Ralser E, Mueller W, Haberland C, et al. Rehospitalization in the first 2 years of life in children born preterm. Acta Paediatr. 2012;101(1):e1–5.

    CrossRef  PubMed  Google Scholar 

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Correspondence to Scott A. Lorch MD, MSCE .

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Lorch, S.A., Calhoun, S. (2017). Adverse Outcomes Do Not Stop at Discharge: Post-NICU Health Care Use by Prematurely Born Infants. In: Hibbs, A., Muhlebach , M. (eds) Respiratory Outcomes in Preterm Infants. Respiratory Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-48835-6_8

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  • DOI: https://doi.org/10.1007/978-3-319-48835-6_8

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