Risk Factors and Costs of Hospital Admissions in First Year of Life: A Population-Based Study

Lain, Samantha J.; Nassar, Natasha; Bowen, Jennifer R.; Roberts, Christine L.

doi:10.1016/j.jpeds.2013.04.051

Cited by 40 publications

(51 citation statements)

References 34 publications

(40 reference statements)

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“…In Australia, each additional completed week of gestation was found to reduce mean cost during the first year of life by 10% and 27% for infants with and without severe neonatal morbidity, respectively. 24 Prevention of the synergistic combination of birth defects and preterm birth may yield higher cost savings.…”

Section: Discussionmentioning

confidence: 99%

“…Among infants who are relatively healthy, the association of preterm birth with increased expenditures is lower than it is among those with severe neonatal morbidity. 24 The implication is that the estimates of per-child expenditures associated with preterm birth (especially late preterm birth) may be substantially overstated by using stand-alone administrative databases. On the other hand, the incomplete sensitivity of the ICD-9-CM codes for ascertaining preterm births does not bias aggregate estimates of expenditures; rather, the aggregate estimates are conservative because they do not include any incremental health care cost for late preterm infants who are not coded as preterm.…”

Section: Discussionmentioning

confidence: 99%

“…2, 5 A linkage of databases in New South Wales, Australia, has also generated estimates of the impact of preterm birth on health care costs during infancy and the first 6 years of life. 24, 28 Similarly, linked databases have been used to assess health care use and costs for infants and young children with birth defects. 9 …”

Section: Discussionmentioning

confidence: 99%

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Employer-Sponsored Plan Expenditures for Infants Born Preterm

et al. 2017

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BACKGROUND Care for infants born preterm or with major birth defects is costly. Specific estimates of financial burden for different payers are lacking, in part because use of administrative data to identify preterm infants and costs is challenging. METHODS We used private health insurance claims data and billing codes to identify live births during 2013 and calculated first-year expenditures for employer-sponsored health plans for infants born preterm, both overall and stratified by major birth defects. RESULTS We conservatively estimated that 7.7% of insured infants born preterm accounted for 37% of $2.0 billion spent by participating plans on the care of infants born during 2013. With a mean difference in plan expenditures of ~$47 100 per infant, preterm births cost the included plans an extra $600 million during the first year of life. Extrapolating to the national level, we projected aggregate employer-sponsored plan expenditures of $6 billion for infants born preterm during 2013. Infants with major birth defects accounted for 5.8% of preterm births but 24.5% of expenditures during infancy. By using an alternative algorithm to identify preterm infants, it was revealed that incremental expenditures were higher: $78 000 per preterm infant and $14 billion nationally. CONCLUSION Preterm births (especially in conjunction with major birth defects) represent a substantial burden on payers, and efforts to mitigate this burden are needed. In addition, researchers need to conduct studies using linked vital records, birth defects surveillance, and administrative data to accurately and longitudinally assess per-infant costs attributable to preterm birth and the interaction of preterm birth with major birth defects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Employer-Sponsored Plan Expenditures for Infants Born Preterm

et al. 2017

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“…9 Infants born at 37 to 38 weeks' gestation have been shown to have an increased risk for readmission for jaundice previously 10 ; however, the impact of early discharge on these infants has not been investigated. An increasing amount of research about early term infants has shown these infants have more neonatal morbidity, 20 poorer long-term general health, 21 higher health service use and costs, 13 and poorer educational results 22 than infants born at 39 to 41 weeks' gestation.…”

Section: Figurementioning

confidence: 99%

“…13 The aims of this study are to (1) examine the association between early discharge from hospital after birth, week of gestational age, and readmission to hospital for jaundice among term infants; and (2) investigate the perinatal risk factors for readmission to hospital for jaundice among infants discharged early.…”

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Early Discharge of Infants and Risk of Readmission for Jaundice

et al. 2015

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OBJECTIVES: To examine the association between early discharge from hospital after birth and readmission to hospital for jaundice among term infants, and among infants discharged early, to investigate the perinatal risk factors for readmission for jaundice.METHODS: Birth data for 781 074 term live-born infants born in New South Wales, Australia from 2001 to 2010 were linked to hospital admission data. Logistic regression models were used to investigate the association between postnatal length of stay (LOS), gestational age (GA), and readmission for jaundice in the first 14 days of life. Other significant perinatal risk factors associated with readmission for jaundice were examined for infants discharged in the first 2 days after birth.RESULTS: Eight per 1000 term infants were readmitted for jaundice. Infants born at 37 weeks' GA with an LOS at birth of 0 to 2 days were over 9 times (adjusted odds ratio [aOR] 9.43; 95% CI, and at 38 weeks' GA were 4 times (aOR 4.05; 95% CI, 3.62-4.54) more likely to be readmitted for jaundice compared with infants born at 39 weeks' GA with an LOS of 3 to 4 days. Other significant risk factors for readmission for jaundice for infants discharged 0 to 2 days after birth included vaginal birth, born to mothers from an Asian country, born to first-time mothers, or being breastfed at discharge.CONCLUSIONS: This study can inform guidelines or policy about identifying infants at risk for readmission for jaundice and ensure that appropriate post-discharge follow-up is received.WHAT'S KNOWN ON THIS SUBJECT: Studies examining early postnatal discharge and readmission for jaundice report conflicting results. Infants born 37 to 38 weeks' gestation have an increased risk for readmission for jaundice; however, the impact of early discharge on this group has not been investigated. WHAT THIS STUDY ADDS:Early postnatal discharge was significantly associated with readmission for jaundice. Of the infants discharged early, those born 37 to 38 weeks' gestation, born via vaginal delivery, born to Asian mothers, or were breastfed had the greatest risk for readmission. Dr Lain participated in the study design, took primary responsibility of the data analysis, and drafted the initial manuscript; Associate Professor Roberts participated in the study design and data analysis and interpretation, and reviewed and revised manuscript; Dr Bowen participated in interpretation of the data and revision of manuscript for important clinical content; Associate Professor Nassar participated in the study design and data analysis and interpretation, and reviewed and revised manuscript; and all authors approved the final manuscript as submitted. The length of stay (LOS) in hospital after the birth of a child has been a controversial topic over the past few decades. A Cochrane Review found early postnatal discharge, defined as earlier than standard care, to have no adverse effects on breastfeeding and maternal depression when accompanied by a policy of nursing/midwifery home visits. However, they reported more re...

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Relationship between large and small for gestational age and hospital readmission after postpartum discharge: a population-based, data-linkage study

et al. 2023

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To determine the association of small (SGA) and large (LGA) for gestational age at birth with hospital readmission after postpartum discharge for up to 28 days of delivery MethodsPopulation-based linkage study using the French National Uniform Hospital Discharge Database.'Healthy' singleton term infants born between January 1st, 2017 and November 30th, 2018 in the French South region were included. SGA and LGA were de ned as birth weight < 10th and > 90th percentiles, respectively, according to sex and gestational age. A multivariable regression analysis was performed. ResultsAmong 67,359 included infants, 2441 (3.6%) were re-admitted and 61% of them were hospitalized within 14 days postpartum. Hospitalized infants were more likely to be LGA at birth (10.3% vs. 8.6% in nonhospitalized infants, p < 0.01); the proportion of SGA infants did not differ between both groups. Compared to appropriate birth weight for GA (AGA) infants, LGA infants were more often hospitalized for infectious diseases (57.7% vs. 51.3%, p = 0.05). After regression analysis LGA infants had a 20% higher odds of being hospitalized than those born AGA (aOR(95%CI) = 1.21 (1.06-1.39)) while aOR(95%CI) for SGA was 1.11 (0.96-1.28). ConclusionsIn contrast to SGA, LGA was associated with hospital readmission during the rst month of life. Follow-up protocols that include LGA should be evaluated. What Is KnownNewborns are at high risk of hospital re-admission during the post-partum period. Prematurity, male, siblings, young mother, living in deprived socioeconomic conditions, or discharged early after delivery are known risk factors. However, the in uence of appropriateness for gestational age at birth, i.e. being born small-for-gestational age (SGA) or large-for-gestational age (LGA), has been little evaluated. What is knew:In contrast to SGA born infants, we found that infants born LGA were at high risk of hospital admission and the main cause was infectious diseases. This population should be considered at risk of early

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Risk Factors and Costs of Hospital Admissions in First Year of Life: A Population-Based Study

Cited by 40 publications

References 34 publications

Employer-Sponsored Plan Expenditures for Infants Born Preterm

Employer-Sponsored Plan Expenditures for Infants Born Preterm

Early Discharge of Infants and Risk of Readmission for Jaundice

Relationship between large and small for gestational age and hospital readmission after postpartum discharge: a population-based, data-linkage study

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