Risk factors for hospital readmission among infants with prolonged neonatal intensive care stays

Rubinos, Laura H.; Foster, Carolyn C.; Machut, Kerri Z.; Snyder, Alexis; Simpser, Eddie; Hall, Matt; Casto, Elizabeth; Berry, Jay G.

doi:10.1038/s41372-021-01276-3

Cited by 8 publications

(6 citation statements)

References 45 publications

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“…A separate analysis of unscheduled readmissions showed similar results. Additionally, public insurance use increased unscheduled readmissions in our patients, which was concordant with multicenter data involving children/infants, where public insurance use was a risk factor for readmissions 26,27 . In contrast, public insurance use was not associated with unplanned readmissions in pediatric neurology/epilepsy patients 28,29 .…”

Section: Discussionsupporting

confidence: 88%

“…Attributes of medical complexity (poorly controlled epilepsy, need for technology use, and multispecialty care) led to increased readmissions in our study. This complements the reports of intensive inpatient resource use seen in patients with chronic care conditions (epilepsy and developmental disability included) with technology use, 18,23,29 as well as in those with indwelling medical devices during the first 3 years of life 26,27 …”

Section: Discussionsupporting

confidence: 58%

“…Additionally, public insurance use increased unscheduled readmissions in our patients, which was concordant with multicenter data involving children/infants, where public insurance use was a risk factor for readmissions. 26,27 In contrast, public insurance use was not associated with unplanned readmissions in pediatric neurology/epilepsy patients. 28,29 The discrepancy may be due to inclusion of older patients (mean age at readmission 7.6 years) or exclusion of infants in these studies.…”

Section: Discussionmentioning

confidence: 95%

“…This complements the reports of intensive inpatient resource use seen in patients with chronic care conditions (epilepsy and developmental disability included) with technology use, 18,23,29 as well as in those with indwelling medical devices during the first 3 years of life. 26,27 Within 2 years of diagnosis, our patients experienced an intense cluster of readmissions (40% had ≥5 readmissions within 2 years), which may be intrinsic to the Abbreviations: CI, confidence interval; OR, Odds expected progression of this disorder, as ~50% of IESS patients have IESS and other seizure types occur in 30-78% within 12-18 months after IESS onset. 7,[30][31][32] We consider this high volume of care experienced by our patients to be excessive.…”

Section: Discussionmentioning

confidence: 97%

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Hospital readmissions in children with new‐onset infantile epileptic spasms syndrome

et al. 2023

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Objective To describe inpatient resource use in the 2 years following infantile epileptic spasms syndrome (IESS) diagnosis, examine the association between clinical/demographic variables and incidence of readmission, and identify risk factors/reasons for frequent readmissions. Methods Retrospective cohort analysis of readmissions (scheduled/unscheduled) within the first 2 years following IESS diagnosis, details of readmissions (number/time between rehospitalizations, and length of stay), demographic/clinical variables, and reasons for readmissions were collected. Negative binomial regression analysis evaluated associations between incidence of readmissions (both scheduled/unscheduled and unscheduled alone) and demographic/clinical factors. Logistic regression assessed the risk of having recurrent readmissions (≥5 readmissions). Results Among 93 (60% males) new‐onset IESS patients, there were 394 readmissions (56% scheduled and 44% unscheduled) within 2‐years following IESS diagnosis. Mean length of stay was 3.5 days (SD: 5.9). Readmissions occurred in 82 patients (88%) and 37 (40%) experienced ≥5 readmissions. On multivariate regression analysis, readmissions were increased with use of multiple first‐line treatments for IESS (P = 0.006), technology assistance (P ≤ 0.001), and multispecialty care (P = 0.01); seizure freedom (P = 0.015) and known etiology (P = 0.011) lowered the incidence of readmissions. Examining unscheduled readmissions separately, increased readmissions occurred with public insurance (P = 0.013), technology use (P ≤ 0.0.001), and multispecialty care (P = 0.013); seizure freedom decreased unscheduled readmissions (P = 0.006). Technology assistance (G‐tube, NG tube, VP shunt, and tracheostomy use) increased the odds (P = 0.007) for recurrent readmissions. Reasons for readmissions included EEG monitoring (protocol driven for verification of IESS remission/characterization of events/EEG surveillance/presurgical monitoring) (51%), acute medical issues (21%), and seizure exacerbation (15%). Protocol‐driven readmissions declined an estimated 52% following protocol modification during the study. Significance In the 2 years following IESS diagnosis, there is substantial inpatient resource use with nearly 40% experiencing ≥5 readmissions (mostly epilepsy related). Since readmissions are increased by intrinsic patient characteristics such as medical complexity (technology use and multispecialty care) or epilepsy‐related issues, the preventability of readmissions is uncertain, except for protocol‐driven ones.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 97%

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Hospital readmissions in children with new‐onset infantile epileptic spasms syndrome

et al. 2023

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“…Recent studies have reported that neonates with gastrostomy tubes are twice as likely to be readmitted to the hospital after discharge. 36 The most common issues associated with gastrostomy tubes include leaking, mild clogging, and granulation tissue. 4 The rate of gastrostomy tube placement among children with a tracheostomy is high with more than two-thirds obtaining them for enteral feeding.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Visits and Hospitalizations After Pediatric Tracheostomy

et al. 2022

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Objective: To determine factors associated with frequent emergency department (ED) visits and hospitalizations after pediatric tracheostomy.Methods: A prospective cohort of children (<18 years) with a tracheostomy placed at a tertiary children's hospital between 2015 and 2019 were followed for 24 months after index discharge. ED visits and hospitalizations were recorded to identify risk factors for frequent utilization (≥4 visits).Results: A total of 239 children required 1285 total visits to the ED or hospital after index discharge with 112 children (47%) having ≥4 visits. Respiratory-related illness was the most common reason (N = 699, 54%) followed by gastrostomy tube issues (N = 119, 9.3%). Frequent utilization was associated with Black race (

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Baby Steps: Improving the Transition from Hospital to Home for Neonatal Patients and Caregivers Through a Nurse-Led Telehealth Program

Sarik

Matsuda²

2023

Worldwide Successful Pediatric Nurse-Led Models of Care

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Risk factors for hospital readmission among infants with prolonged neonatal intensive care stays

Cited by 8 publications

References 45 publications

Hospital readmissions in children with new‐onset infantile epileptic spasms syndrome

Hospital readmissions in children with new‐onset infantile epileptic spasms syndrome

Emergency Department Visits and Hospitalizations After Pediatric Tracheostomy

Baby Steps: Improving the Transition from Hospital to Home for Neonatal Patients and Caregivers Through a Nurse-Led Telehealth Program

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