Identification of Extremely Premature Infants at High Risk of Rehospitalization

OBJECTIVE: Extremely low birth weight infants often require rehospitalization during infancy. Our objective was to identify at the time of discharge which extremely low birth weight infants are at higher risk for rehospitalization. METHODS: Data from extremely low birth weight infants in Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers from 2002–2005 were analyzed. The primary outcome was rehospitalization by the 18- to 22-month follow-up, and secondary outcome was rehospitalization for respiratory causes in the first year. Using variables and odds ratios identified by stepwise logistic regression, scoring systems were developed with scores proportional to odds ratios. Classification and regression-tree analysis was performed by recursive partitioning and automatic selection of optimal cutoff points of variables. RESULTS: A total of 3787 infants were evaluated (mean ± SD birth weight: 787 ± 136 g; gestational age: 26 ± 2 weeks; 48% male, 42% black). Forty-five percent of the infants were rehospitalized by 18 to 22 months; 14.7% were rehospitalized for respiratory causes in the first year. Both regression models (area under the curve: 0.63) and classification and regression-tree models (mean misclassification rate: 40%–42%) were moderately accurate. Predictors for the primary outcome by regression were shunt surgery for hydrocephalus, hospital stay of >120 days for pulmonary reasons, necrotizing enterocolitis stage II or higher or spontaneous gastrointestinal perforation, higher fraction of inspired oxygen at 36 weeks, and male gender. By classification and regression-tree analysis, infants with hospital stays of >120 days for pulmonary reasons had a 66% rehospitalization rate compared with 42% without such a stay. CONCLUSIONS: The scoring systems and classification and regression-tree analysis models identified infants at higher risk of rehospitalization and might assist planning for care after discharge.

[1]  D. Nilsson,et al.  Long-Term Outcome after Treatment of Hydrocephalus in Children , 2010, Pediatric Neurosurgery.

[2]  B. Poindexter,et al.  Neonatal Outcomes of Extremely Preterm Infants From the NICHD Neonatal Research Network , 2010, Pediatrics.

[3]  W. Carlo,et al.  PaCO2 and neurodevelopment in extremely low birth weight infants. , 2009, The Journal of pediatrics.

[4]  L. Lehtonen,et al.  Morbidities and Hospital Resource Use During the First 3 Years of Life Among Very Preterm Infants , 2009, Pediatrics.

[5]  W. Carlo,et al.  Cytokines Associated With Bronchopulmonary Dysplasia or Death in Extremely Low Birth Weight Infants , 2009, Pediatrics.

[6]  G. Caldito,et al.  Ventricular reservoirs and ventriculoperitoneal shunts for premature infants with posthemorrhagic hydrocephalus: an institutional experience. , 2009, Journal of neurosurgery. Pediatrics.

[7]  Nehal A Parikh,et al.  Intensive care for extreme prematurity--moving beyond gestational age. , 2008, The New England journal of medicine.

[8]  W. Gilbert,et al.  Cost, causes and rates of rehospitalization of preterm infants , 2007, Journal of Perinatology.

[9]  Karalee Poschman,et al.  Cost of Hospitalization for Preterm and Low Birth Weight Infants in the United States , 2007, Pediatrics.

[10]  A. Marini.  Early prediction of poor outcome in extremely low birth weight infants by classification tree analysis. , 2007, The Journal of pediatrics.

[11]  Jon E. Tyson,et al.  Predicting Outcomes of Neonates Diagnosed With Hypoxemic-Ischemic Encephalopathy , 2006, Pediatrics.

[12]  B. Schmidt,et al.  Early prediction of poor outcome in extremely low birth weight infants by classification tree analysis. , 2006, The Journal of pediatrics.

[13]  B. Morris,et al.  Rehospitalization of Extremely Low Birth Weight (ELBW) Infants: Are There Racial/Ethnic Disparities? , 2005, Journal of Perinatology.

[14]  B. Resch,et al.  Rehospitalisations for respiratory disease and respiratory syncytial virus infection in preterm infants of 29-36 weeks gestational age. , 2005, The Journal of infection.

[15]  M. Walsh,et al.  Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes. , 2005, The Journal of pediatrics.

[16]  B. Vohr,et al.  Neurodevelopmental and Growth Outcomes of Extremely Low Birth Weight Infants After Necrotizing Enterocolitis , 2005, Pediatrics.

[17]  G. Breart,et al.  Re‐hospitalization in infants younger than 29 weeks’ gestation in the EPIPAGE cohort , 2004, Acta paediatrica.

[18]  M. Rennels,et al.  Revised indications for the use of palivizumab and respiratory syncytial virus immune globulin intravenous for the prevention of respiratory syncytial virus infections. , 2003, Pediatrics.

[19]  B. Schmidt,et al.  Impact of Bronchopulmonary Dysplasia, Brain Injury, and Severe Retinopathy on the Outcome of Extremely Low-Birth-Weight Infants at 18 Months: Results From the Trial of Indomethacin Prophylaxis in Preterms , 2003 .

[20]  A. R. Controlled,et al.  Comprehensive follow-up care and life-threatening illnesses among high-risk infants: A randomized controlled trial. , 2000, JAMA.

[21]  B. Vohr,et al.  Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. , 2000, Pediatrics.

[22]  D A Bloch,et al.  Recursive partitioning for the identification of disease risk subgroups: a case-control study of subarachnoid hemorrhage. , 1998, Journal of clinical epidemiology.

[23]  T. O'Shea,et al.  Association between the severity of chronic lung disease and first-year outcomes of very low birth weight infants. , 1997, Journal of perinatology : official journal of the California Perinatal Association.

[24]  M. Hack,et al.  Hospitalization as a measure of morbidity among very low birth weight infants with chronic lung disease. , 1996, The Journal of pediatrics.