Comprehensive Follow-up Care and Life-Threatening Illnesses Among High-Risk Infants

Broyles, R. Sue; Tyson, Jon E.; Heyne, Elizabeth T.; Heyne, Roy J.; Hickman, Jackie F.; Swint, Michael; Adams, Sally S.; West, Linda; Pomeroy, Nancy; Hicks, Patricia J.; Ahn, Chul

doi:10.1001/jama.284.16.2070

Cited by 94 publications

(67 citation statements)

References 27 publications

(29 reference statements)

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“…13 Structured post-NICU discharge follow-up care can substantially save net healthcare costs by safely facilitating earlier discharge from the NICU [14][15][16] and decreasing the incidence of lifethreatening illnesses and intensive care admissions in first year of life. 17 Follow-up clinics may not be directly profitable to the hospitals, but they help in substantially lowering the total healthcare costs related to prematurity. As the preterm and low birth weight rates continue to rise 18 and the survival rates of highrisk infants continues to improve, robust high-risk infant follow-up care programs become vital in decreasing the burden of prematurity-related healthcare costs.…”

Section: Discussionmentioning

confidence: 99%

Current state of high-risk infant follow-up care in the United States: results of a national survey of academic follow-up programs

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Current state of high-risk infant follow-up care in the United States: results of a national survey of academic follow-up programs

et al. 2011

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“…One center has reported a randomized trial of primary care for ELBW infants and has shown a decrease in readmissions to the pediatric intensive care unit, a decrease in intensive care days, and a reduction in cost of overall health care. 31 Other services provided at various centers include regular phone calls, periodic developmental assessments, and case management support. Therefore, the effects of racial disparities may have been blunted by the efforts of the investigators to include all infants regardless of race or ethnicity, primary care at some institutions, and the support services offered by all the followup programs.…”

Section: Discussionmentioning

confidence: 99%

Rehospitalization of Extremely Low Birth Weight (ELBW) Infants: Are There Racial/Ethnic Disparities?

2005

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Premature infants are at increased risk for rehospitalization after discharge from the hospital. Racial disparities are known to exist in pediatric health care. OBJECTIVE:To evaluate whether racial disparities exist in the proportion of extremely low birth weight (ELBW) infants rehospitalized prior to 18 months corrected age and the causes of rehospitalization. METHODS:The National Institute of Child Health and Human Development Neonatal Research Network database was used to identify all ELBW infants (n ¼ 2446) who were born between November 1, 1998 and May 31, 2000 at the 14 participating centers and discharged alive (n ¼ 1591). Infants were seen at 18-22 months corrected age for followup. Data related to maternal variables, race, socioeconomic status, medical morbidities, insurance, and rehospitalizations were recorded from the medical record and parent interview. Logistic regression analyses were used to examine the relationship of race/ethnicity and rehospitalization while controlling for gestational age, gender, center, maternal education, family income, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, ventriculoperitoneal (VP) shunt, respiratory syncytial virus (RSV) prophylaxis, and insurance type. RESULTS:In all, 1405 (88%) infants were evaluated at followup. The racial distribution of infants admitted, discharged, seen at followup, and rehospitalized were similar. Rehospitalization occurred at least once in 49% of the infants. In the logistic regression analyses, race was not a significant predictor for rehospitalization. The odds of rehospitalization were related to low family income, type of insurance, BPD, VP shunt, RSV prophylaxis, and center. CONCLUSION:Race was not a predominant variable in the risk of rehospitalization in this cohort of ELBW infants. Medical morbidities and low family income appear to be the major risk factors for rehospitalization.

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“…[1][2][3][4][5] These rehospitalizations are accompanied by significant morbidity and sometimes mortality 4,5 and occur at high cost to the family as well as society. 4,6 Strategies such as the use of prophylaxis for respiratory syncytial virus infections 7 and comprehensive follow-up care 8 are designed to reduce these rehospitalizations. Few studies have evaluated models to predict which prematurely born infants will need rehospitalization or will have persistent respiratory problems after discharge from the hospital.…”

mentioning

confidence: 99%

Identification of Extremely Premature Infants at High Risk of Rehospitalization

et al. 2011

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WHAT'S KNOWN ON THIS SUBJECT:Extremely low birth weight infants are at high risk of rehospitalization in infancy, often for respiratory illnesses. Few studies have evaluated which prematurely born infants will need rehospitalization or will have persistent respiratory problems after discharge. WHAT THIS STUDY ADDS:Scoring systems and classification and regression-tree analysis models were developed to identify extremely low birth weight infants at higher risk of rehospitalization and might help target interventions to infants at higher risk and assist in planning quality improvement initiatives. abstract 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 Ϯ SD birth weight: 787 Ϯ 136 g; gestational age: 26 Ϯ 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 Ͼ120 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 Ͼ120 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.

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Comprehensive Follow-up Care and Life-Threatening Illnesses Among High-Risk Infants

Abstract: Comprehensive follow-up care by experienced caregivers can be highly effective in reducing life-threatening illness without increasing costs among high-risk inner-city infants. JAMA. 2000;284:2070-2076.

Cited by 94 publications

References 27 publications

Current state of high-risk infant follow-up care in the United States: results of a national survey of academic follow-up programs

Current state of high-risk infant follow-up care in the United States: results of a national survey of academic follow-up programs

Rehospitalization of Extremely Low Birth Weight (ELBW) Infants: Are There Racial/Ethnic Disparities?

Identification of Extremely Premature Infants at High Risk of Rehospitalization

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