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Li J, Zhang X, Ye F, Cheng X, Yu L. Factors affecting parental role adaptation in parents of preterm infants after discharge: a cross-sectional study. Front Psychol 2024; 15:1396042. [PMID: 38962227 PMCID: PMC11221409 DOI: 10.3389/fpsyg.2024.1396042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
Background Parenting a preterm infant can be incredibly challenging and stressful, particularly in the first year after discharge. Desirable parental role adaptation leads to appropriate parenting behaviors and parent-infant interaction, which are essential to child health and development. Aim To investigate the level of parental role adaptation and its influencing factors among parents of preterm infants in the first year after hospital discharge according to Belsky's parenting process model among parents of preterm infants in the first year after hospital discharge. Methods A cross-sectional study design was adopted using convenience sampling. Data were collected using the Parental Role Adaptation Scale (PRAS) in parents with preterm infants, the Perceived Social Support Scale (PSSS), the Coping Adaptation Processing Scale (CAPS-15), and a sociodemographic questionnaire. Descriptive statistics, non-parametric tests, Spearman correlation analyses, and multivariate linear regression were used to analyze the data. Results In total, 300 Chinese parents were included in the analysis. In the multivariate analysis, first-time parent (p = 0.003), master's degree and above (p = 0.042), coping adaptation processing (p = 0.000), residence location (towns: p = 0.019, city: p = 0.028), monthly family income (6000-10,000: p = 0.000, >10,000: p = 0.000), and perceived social support (p = 0.001) were all significant predictors of parental role adaptation and collectively accounted for 56.8% of the variation in parental role adaptation of parents with preterm infants (F = 16.473, p < 0.001). Coping adaptation processing mediated the relationship between perceived social support and parental role adaptation (95% bootstrap CI = 0.022, 0.130). Conclusion Chinese parents of preterm infants experience a moderate level of parental role adaptation when their child is discharged from the hospital to home. Parents who are not first-time parents, have master's degrees or above, live in towns or cities, have higher coping and adaptation abilities, have high monthly family income, and greater perceived social support have a higher level of parental role adaptation. Healthcare providers should pay more attention to parents with low socioeconomic status and encourage them to improve their coping and adaptation abilities and to utilize their formal and informal social support networks.
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Affiliation(s)
- Jia Li
- Department of Nursing, Zhongnan Hospital, Wuhan University, Wuhan, Hebei, China
- School of Nursing, Center for Nurturing Care Research, Wuhan University, Wuhan, China
| | - Xiaohong Zhang
- Department of Pediatrics, Xiangyang Central Hospital, Xiangyang, China
| | - Fei Ye
- Department of Nursing, Fifth Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Xiaolin Cheng
- Department of Nursing, Zhongnan Hospital, Wuhan University, Wuhan, Hebei, China
| | - Liping Yu
- School of Nursing, Center for Nurturing Care Research, Wuhan University, Wuhan, China
- Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
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2
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Ahmad K, Keramat SA, Sathi NJ, Kabir E, Khanam R. Association of infant and child health characteristics with the hazard of any medical condition or disability in Australian children. Arch Public Health 2022; 80:158. [PMID: 35733191 PMCID: PMC9219216 DOI: 10.1186/s13690-022-00913-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background The incidence of any medical condition (e.g., sight, hearing, and speech problems, blackouts, chronic pain etc.) or disability (e.g., limited use of arms or fingers, legs, and feet, or other physical long-term health condition limiting everyday activities etc.) have been increasing among Australian children in recent decades. Objectives This study assessed whether infant or child health characteristics might be predictors of subsequent medical conditions or disabilities in children in the first 15 years of life. Methods Using time to event data of 5107 children, obtained from the Birth cohort of the Longitudinal Study of Australian Children, the study estimated the incidence of any medical condition or disability using the survival analysis technique. This study followed up the children from birth to 14 or 15 years of age (2004–2018) and assessed the association of infant and child health characteristics (birthweight, gestational age, use of intensive care unit or ventilator during their neonatal age and obesity) with hazard of any medical condition or disability using the random effect parametric survival regression model. The infant characteristics were measured in the Wave 1 while the children were aged 0/1 year and obesity characteristics were measured longitudinally over all the waves up to 14/15 years of age. Results The hazard rate of any medical condition or disability for all participants was 26.13 per 1000 person-years among children in Australia. This hazard incidence rate was higher among low birthweight (39.07) children compared to the children of normal birthweight (24.89) children. The hazard rate also higher among obese (34.37) children compared to the normal weight children (24.82) and among those who had received after-birth ventilation or intensive care unit emergency services (36.87) compared to those who have not received these services (24.20). The parametric panel regression model also suggests that children with low birthweight were 1.43 times (Hazard Ratio: 1.43, 95% Confidence Interval: 1.05–1.94) more likely to have any medical condition or disability than children with normal birthweight. The time to event analyses also revealed that being recipient of after-birth emergencies (HR: 1.47, 95% CI: 1.23–1.75), being male children (HR: 1.30, 95% CI: 1.14–1.48) or being obese (HR: 1.38, 95% CI: 1.07–1.79) significantly increased the likelihood of the incidence of a medical condition or disability among children. The regression model was adjusted for socio-demographic characteristics of children and mothers.. Conclusions The study findings suggest that infants with low birth weight, hospital emergency service use and children with obesity would benefit from additional health care monitoring to minimize the risk of any medical condition or disability.
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Sun L, Bao Y, Zhang H, Zhu J. Identification of Premature Infants at High Risk of Late Respiratory Diseases: A Retrospective Cohort Study. Front Pediatr 2022; 10:869963. [PMID: 35515352 PMCID: PMC9067161 DOI: 10.3389/fped.2022.869963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Aim To identify infants with very low birth weight at risk of late respiratory diseases after discharge. Methods This retrospective longitudinal study included 388 preterm infants with gestational age of < 32 weeks and birth weight of < 1,500 g and evaluated perinatal information, assessments performed while in the neonatal intensive care unit, and longitudinal follow-up via questionnaire until the corrected gestational age of 18-24 months. Results The mean birth weight and gestational age were 1,191.2 ± 191.8 g and 29.1 ± 1.4 weeks, respectively. Sixty-four (16.5%) infants developed late respiratory diseases after discharge to the corrected gestational age of 18-24 months. Univariate analyses showed that gestational age, birth weight, respiratory support, oxygen use, bronchopulmonary dysplasia diagnosed at 36 weeks' postmenstrual age and length of hospital stay were associated with late respiratory diseases. After adjusting for covariates, respiratory support was significantly associated with serious respiratory morbidities to 18-24 months corrected gestational age. With each day of respiratory support, the odds of late respiratory diseases increased by 1.033-fold. Conclusion Respiratory support was associated with increased odds of developing late respiratory diseases during early childhood, which may be an early predictor to late respiratory morbidities. Thus, it is imperative to identify a safe and effective strategy to prevent chronic dependency on respiratory support.
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Affiliation(s)
| | | | | | - Jiajun Zhu
- Department of Neonatology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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4
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Yue W, Wei H, Chen F, Chen X, Xu ZE, Hu Y. Risk factors and prediction score model for unplanned readmission among neonates with NRDS under one year of age: A retrospective cohort study. Front Pediatr 2022; 10:964554. [PMID: 36313871 PMCID: PMC9606800 DOI: 10.3389/fped.2022.964554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/20/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aimed to analyze the risk factors and establish a prediction score model for unplanned readmission among neonates with neonatal respiratory distress syndrome (NRDS) for respiratory problems under one year of age. METHODS This retrospective cohort study enrolled 230 neonates with NRDS who were admitted between January 2020 and December 2020. The infants were classified into two subgroups based on whether they were readmitted for respiratory problems under one year of age: readmit group and non-readmit group. Readmission risk factors for NRDS were analyzed by logistic regression and a prediction score model was generated. RESULTS Among the 230 enrolled infants, 51 (22%) were readmitted, and 179 (78%) were not readmitted. In univariate analysis, compared with non-readmit group infants, readmit group infants had a significantly younger birth gestational age (31.9 ± 2.3 vs. 32.8 ± 2.5 weeks, p = 0.012), lower birth weight (1,713.7 ± 501.3 g vs. 1,946.8 ± 634.4 g, p = 0.007), older age at discharge (41.7 vs. 31.7 days, p = 0.012), higher proportion of necrotizing enterocolitis (NEC) (31% vs. 16%, p = 0.016), higher rate of blood transfusion (39% vs. 25%, p = 0.049), higher rate of postnatal dexamethasone (DEX) administration (28% vs. 9.5%, p = 0.001), and higher rate of home oxygen therapy (HOT) (57% vs. 34%, p = 0.003). Moreover, readmit group infants had significantly longer antibiotic days usage (12.0 vs. 10.0 days, p = 0.026) and a longer duration of hospital stay (41.0 vs. 31.0 days, p = 0.012) than non-readmit group infants. The multivariate logistic regression analysis showed that taking readmission as a target variable, postnatal DEX administration (OR: 2.689, 95% CI: 1.168-6.189, p = 0.020), HOT (OR: 2.071, 95% CI: 1.060-4.046, p = 0.033), and NEC (OR: 2.088, 95% CI: 0.995-4.380, p = 0.051) could be regarded as risk factors for readmission. A scoring model predicting readmission was administered with a positive predictive value of 0.651 (95% CI: 0.557-0.745, p = 0.002), with a sensitivity of 0.412 and a specificity of 0.888 at a cut-off of 3.5 points, which were evaluated on the receiver operating characteristic curve. CONCLUSIONS Postnatal DEX administration, HOT, and NEC were risk factors for readmission of NRDS. NRDS infants with a predictive score of 3.5 points or more were at high risk for unplanned readmission.
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Affiliation(s)
- Weihong Yue
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hong Wei
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Feng Chen
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xinhong Chen
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhen-E Xu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ya Hu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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5
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Maddux AB, Mourani PM, Banks R, Reeder RW, Pollack MM, Berg RA, Meert KL, McQuillen PS, Yates AR, Notterman DA, Berger JT. Inhaled Nitric Oxide Use and Outcomes in Critically Ill Children With a History of Prematurity. Respir Care 2021; 66:1549-1559. [PMID: 34552014 PMCID: PMC8810581 DOI: 10.4187/respcare.08766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Inhaled nitric oxide (INO) is used to treat hypoxic respiratory failure without clear evidence of benefit. Future trials to evaluate its use will be designed based on an understanding of the populations in which this therapy is provided and with outcomes based on patient characteristics, for example, a history of premature birth. METHODS This was a multi-center prospective observational study that evaluated subjects in the pediatric ICU who were treated with INO for a respiratory indication, excluding those treated in the neonatal ICU or treated for birth-related disease. We used logistic regression to evaluate characteristics associated with mortality and duration of mechanical ventilation. Specifically, we compared subjects born early preterm (<32 weeks post-conceptual age), late preterm (32-37 weeks post-conceptual age), and full term. RESULTS A total of 163 children (median age [interquartile range], 1.8 [0.7-6.0] y) were included, 41 (25.2%) had a history of preterm birth (18 born early preterm and 23 born late preterm). INO was initiated for less-severe lung disease in the early preterm versus late preterm versus full-term subjects (median mean airway pressures, 16 vs 19 vs 19 cm H2O; P = .03), although the oxygenation index and oxygenation saturation index did not differ. The early preterm subjects had more ventilator-free days (median, 18.0, 7.0, 4.5 d; P = .02) and lower 28-d mortality (0, 26.1, 32.0%; P = .007). Lower respiratory tract disease, but not a history of prematurity, was independently associated with lower mortality. CONCLUSIONS INO was used differently in early preterm subjects. Clinical trials that evaluate INO use should have standardized oxygenation deficit thresholds for initiation of therapy and should consider stratifying by early preterm status.
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Affiliation(s)
- Aline B Maddux
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
| | - Peter M Mourani
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | | | | - Robert A Berg
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Andrew R Yates
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Daniel A Notterman
- Department of Molecular Biology, Princeton University, Princeton, New Jersey
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Pattnaik P, Palmaccio S, Aschner J, Eisenberg R, Choi J, LaTuga MS. Does Duration Off Respiratory Support Prior to Discharge from NICU Predict Hospital Readmission among Extremely Low Gestational Age Neonates? Am J Perinatol 2021; 38:e330-e337. [PMID: 32369861 DOI: 10.1055/s-0040-1710011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Our objective was to determine if the duration off respiratory support prior to discharge home from the neonatal intensive care unit (NICU) would impact hospital readmission rates among extremely low gestational age neonates (ELGAN). STUDY DESIGN In this retrospective chart review, we examined readmission rates for ELGAN admitted to the Montefiore-Weiler NICU between 2013 and 2015. RESULTS Of 140 infants born at <29 weeks' gestational age, 30 (21%) of these infants were subsequently readmitted within 90 days, primarily for respiratory complaints. Readmitted infants were born at an earlier gestational age (median = 26 weeks; interquartile range [IQR]: 24-27 weeks) compared to infants who did not require readmission (median = 27 weeks; IQR: 25-28 weeks), p = 0.03. Birth weights were smaller among infants who required readmission, 800 ± 248 g compared to 910 ± 214 g (p = 0.02). Infants with Hispanic ethnicity and those discharged during the spring season were likely to be readmitted. Duration off respiratory support prior to discharge did not predict 90-day readmission rates. Lower gestational age and birth weight were associated with higher rates of readmissions after NICU discharge. CONCLUSION Duration off and invasiveness of respiratory support prior to discharge did not predict risk of 90-day readmission nor did discharge during months with traditionally higher prevalence of respiratory viruses.
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Affiliation(s)
- Priyam Pattnaik
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Samantha Palmaccio
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Judy Aschner
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.,Department of Pediatrics, Hackensack Meridian School of Medicine at Seton Hall, Nutley, New Jersey
| | - Ruth Eisenberg
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jaeun Choi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - M Susan LaTuga
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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7
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Levin JC, Beam AL, Fox KP, Mandl KD. Medication utilization in children born preterm in the first two years of life. J Perinatol 2021; 41:1732-1738. [PMID: 33547407 PMCID: PMC8277664 DOI: 10.1038/s41372-021-00930-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/12/2020] [Accepted: 01/15/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare medications dispensed during the first 2 years in children born preterm and full-term. STUDY DESIGN Retrospective analysis of claims data from a commercial national managed care plan 2008-2019. 329,855 beneficiaries were enrolled from birth through 2 years, of which 25,408 (7.7%) were preterm (<37 weeks). Filled prescription claims and paid amount over 2 years were identified. RESULTS In preterm children, the number of filled prescriptions was 1.4 times and cost was 3.8 times that of full-term children. Number and cost of medications were inversely related to gestational age. Differences peak at 4-9 months and resolve by 19 months after discharge. Palivizumab, ranitidine, albuterol, lansoprazole, budesonide, and prednisolone had the greatest differences in utilization. CONCLUSION Prescription medication utilization among preterm children under 2 years is driven by palivizumab, anti-reflux, and respiratory medications, despite little evidence regarding efficacy for many medications and concern for harm with certain classes.
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Affiliation(s)
- Jonathan C Levin
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA.
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Andrew L Beam
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kathe P Fox
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
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8
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Do CHT, Børresen ML, Pedersen FK, Geskus RB, Kruse AY. Rates of rehospitalisation in the first 2 years among preterm infants discharged from the NICU of a tertiary children hospital in Vietnam: a follow-up study. BMJ Open 2020; 10:e036484. [PMID: 33020086 PMCID: PMC7537446 DOI: 10.1136/bmjopen-2019-036484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To describe the characteristics of rehospitalisation in Vietnamese preterm infants and to examine the time-to-first-readmission between two gestational age (GA) groups (extremely/very preterm (EVP) vs moderate/late preterm (MLP)); and further to compare rehospitalisation rates according to GA and corrected age (CA), and to examine the association between potential risk factors and rehospitalisation rates. DESIGN AND SETTING A cohort study to follow up preterm infants discharged from a neonatal intensive care unit (NICU) of a tertiary children's hospital in Vietnam. PARTICIPANTS All preterm newborns admitted to the NICU from July 2013 to September 2014. MAIN OUTCOMES Rates, durations and causes of hospital admission during the first 2 years. RESULTS Of 294 preterm infants admitted to NICU (all outborn, GA ranged from 26 to 36 weeks), 255 were discharged alive, and 211 (83%) NICU graduates were followed up at least once during the first 2 years CA, of whom 56% were hospital readmitted. The median (IQR) of hospital stay was 7 (6-10) days. Respiratory diseases were the major cause (70%). Compared with MLP infants, EVP infants had a higher risk of first rehospitalisation within the first 6 months of age (p=0.01). However, the difference in risk declined thereafter and was similar from 20 months of age. There was an interaction in rehospitalisation rates between GA and CA. Longer duration of neonatal respiratory support and having older siblings were associated with higher rehospitalisation rates. Lower rates of rehospitalisation were seen in infants with higher cognitive and motor scores (not statistically significant in cognitive scores). CONCLUSIONS Hospital readmission of Vietnamese preterm infants discharged from NICU was frequent during their first 2 years, mainly due to respiratory diseases. Scale-up of follow-up programmes for preterm infants is needed in low-income and middle-income countries and attempts to prevent respiratory diseases should be considered.
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Affiliation(s)
- Chuong Huu Thieu Do
- Neonatal Intensive Care Unit, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | | | | | - Ronald Bertus Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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9
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Mourani PM, Mandell EW, Meier M, Younoszai A, Brinton JT, Wagner BD, Arjaans S, Poindexter BB, Abman SH. Early Pulmonary Vascular Disease in Preterm Infants Is Associated with Late Respiratory Outcomes in Childhood. Am J Respir Crit Care Med 2020; 199:1020-1027. [PMID: 30303395 DOI: 10.1164/rccm.201803-0428oc] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Early pulmonary vascular disease (PVD) after preterm birth is associated with a high risk for developing bronchopulmonary dysplasia (BPD), but its relationship with late respiratory outcomes during early childhood remains uncertain. OBJECTIVES To determine whether PVD at 7 days after preterm birth is associated with late respiratory disease (LRD) during early childhood. METHODS This was a prospective study of preterm infants born before 34 weeks postmenstrual age (PMA). Echocardiograms were performed at 7 days and 36 weeks PMA. Prenatal and early postnatal factors and postdischarge follow-up survey data obtained at 6, 12, 18, and 24 months of age were analyzed in logistic regression models to identify early risk factors for LRD, defined as a physician diagnosis of asthma, reactive airways disease, BPD exacerbation, bronchiolitis, or pneumonia, or a respiratory-related hospitalization during follow-up. MEASUREMENTS AND MAIN RESULTS Of the 221 subjects (median, 27 wk PMA; interquartile range, 25-28 and 920 g; interquartile range, 770-1090 g) completing follow-up, 61% met LRD criteria. Gestational diabetes and both mechanical ventilator support and PVD at 7 days were associated with LRD. The combination of PVD and mechanical ventilator support at 7 days was among the strongest prognosticators of LRD (odds ratio, 8.1; confidence interval, 3.1-21.9; P < 0.001). Modeled prenatal and early postnatal factors accurately informed LRD (area under the curve, 0.764). Adding BPD status at 36 weeks PMA to the model did not change the accuracy (area under the curve, 0.771). CONCLUSIONS Early echocardiographic evidence of PVD after preterm birth in combination with other perinatal factors is a strong risk factor for LRD, suggesting that early PVD may contribute to the pathobiology of BPD.
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Affiliation(s)
- Peter M Mourani
- 1 The Pediatric Heart Lung Center, Department of Pediatrics.,2 Section of Critical Care
| | - Erica W Mandell
- 1 The Pediatric Heart Lung Center, Department of Pediatrics.,3 Section of Neonatology
| | - Maxene Meier
- 4 Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado
| | | | - John T Brinton
- 6 Section of Pulmonary Medicine, Children's Hospital Colorado and the University of Colorado Anschutz Medical Center, Aurora, Colorado.,4 Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado
| | - Brandie D Wagner
- 1 The Pediatric Heart Lung Center, Department of Pediatrics.,4 Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado
| | - Sanne Arjaans
- 7 University Medical Center Groningen and University of Groningen, Groningen, the Netherlands; and
| | - Brenda B Poindexter
- 8 Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Steven H Abman
- 1 The Pediatric Heart Lung Center, Department of Pediatrics.,6 Section of Pulmonary Medicine, Children's Hospital Colorado and the University of Colorado Anschutz Medical Center, Aurora, Colorado
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10
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Reed RA, Morgan AS, Zeitlin J, Jarreau PH, Torchin H, Pierrat V, Ancel PY, Khoshnood B. Assessing the risk of early unplanned rehospitalisation in preterm babies: EPIPAGE 2 study. BMC Pediatr 2019; 19:451. [PMID: 31752782 PMCID: PMC6870221 DOI: 10.1186/s12887-019-1827-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/08/2019] [Indexed: 11/29/2022] Open
Abstract
Background Gaining a better understanding of the probability, timing and prediction of rehospitalisation amongst preterm babies could help improve outcomes. There is limited research addressing these topics amongst extremely and very preterm babies. In this context, unplanned rehospitalisations constitute an important, potentially modifiable adverse event. We aimed to establish the probability, time-distribution and predictability of unplanned rehospitalisation within 30 days of discharge in a population of French preterm babies. Methods This study used data from EPIPAGE 2, a population-based prospective study of French preterm babies. Only those babies discharged home alive and whose parents responded to the one-year survey were eligible for inclusion in our study. For Kaplan-Meier analysis, the outcome was unplanned rehospitalisation censored at 30 days. For predictive modelling, the outcome was binary, recording unplanned rehospitalisation within 30 days of discharge. Predictors included routine clinical variables selected based on expert opinion. Results Of 3841 eligible babies, 350 (9.1, 95% CI 8.2–10.1) experienced an unplanned rehospitalisation within 30 days. The probability of rehospitalisation progressed at a consistent rate over the 30 days. There were significant differences in rehospitalisation probability by gestational age. The cross-validated performance of a ten predictor model demonstrated low discrimination and calibration. The area under the receiver operating characteristic curve was 0.62 (95% CI 0.59–0.65). Conclusions Unplanned rehospitalisation within 30 days of discharge was infrequent and the probability of rehospitalisation progressed at a consistent rate. Lower gestational age increased the probability of rehospitalisation. Predictive models comprised of clinically important variables had limited predictive ability.
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Affiliation(s)
- Robert Anthony Reed
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France
| | - Andrei Scott Morgan
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France. .,Elizabeth Garrett Anderson Institute for Womens' Health, UCL, London, UK. .,SAMU 93, SMUR Pédiatrique, CHI André Gregoire, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris, Paris, France.
| | - Jennifer Zeitlin
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France
| | - Pierre-Henri Jarreau
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France.,APHP.5, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris, France
| | - Héloïse Torchin
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France.,APHP.5, Service de Médecine et Réanimation Néonatales de Port-Royal, Paris, France
| | - Véronique Pierrat
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre, Lille, France
| | - Pierre-Yves Ancel
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, APHP.5, F-75014, Paris, France
| | - Babak Khoshnood
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, F-75004, Paris, France
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11
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Lau R, Crump RT, Brousseau DC, Panepinto JA, Nicholson M, Engel J, Lagatta J. Parent Preferences Regarding Home Oxygen Use for Infants with Bronchopulmonary Dysplasia. J Pediatr 2019; 213:30-37.e3. [PMID: 31256913 PMCID: PMC6765432 DOI: 10.1016/j.jpeds.2019.05.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/07/2019] [Accepted: 05/29/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine parent preferences for discharge with home oxygen in infants with bronchopulmonary dysplasia. STUDY DESIGN This was a prospective study of parents of infants born at <32 weeks' gestation with established bronchopulmonary dysplasia and approaching neonatal intensive care unit (NICU) discharge. Parents were presented a hypothetical scenario of an infant who failed weaning to room air and 2 options: discharge with home oxygen or try longer to wean oxygen. The initial scenario risks reflected a 1.5-week difference in NICU length of stay and no differences in other outcomes. Length of stay and readmission outcomes were increased or decreased until the parent switched preference. Three months after discharge, parents were asked to reconsider their preference. Differences were analyzed by χ2 or Kruskal-Wallis tests. RESULTS Of 125 parents, 50% preferred home oxygen. For parents preferring home oxygen, the most important reason was comfort at home (79%). Forty percent switched preference when the length of stay difference decreased by 1 week; 35% switched when readmission increased by 5%. For parents preferring to stay in NICU, the most important reason was fear of taking care of the child at home (73%). Thirty-two percent switched preference when the length of stay difference increased by 1 week; 31% switched when readmission decreased by 5%. One hundred ten parents completed the 3-month follow-up; 80 were discharged with home oxygen. Seventy-eight percent would prefer home oxygen (97% who initially preferred home oxygen and 60% who initially preferred to stay in the NICU). CONCLUSIONS Parents weigh differences in NICU length of stay and readmission risk similarly. After discharge, most prefer earlier discharge with home oxygen. Earlier education to increase comfort with home technology may facilitate NICU discharge planning.
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Affiliation(s)
- Ryan Lau
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | | | | | | | - Mateo Nicholson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | | | - Joanne Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
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12
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Hanna Y, Laliberté C, Ben Fadel N, Lemyre B, Thébaud B, Barrowman N, Bijelic V, Hoey L, Katz SL. Effect of oxygen saturation targets on the incidence of bronchopulmonary dysplasia and duration of respiratory supports in extremely preterm infants. Paediatr Child Health 2019; 25:173-179. [PMID: 32296279 DOI: 10.1093/pch/pxz058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/21/2019] [Indexed: 11/13/2022] Open
Abstract
Background Recent clinical practice changes in neonatal care resulted in higher, narrower oxygen saturation target ranges for preterm infants. The effect of targeting higher or lower oxygen saturations on respiratory outcomes of preterm infants and duration of hospitalization has not been extensively reviewed in the context of current care, but could have significant implications. Methods A multicentre retrospective cohort of 145 preterm infants was conducted; 105 had lower oxygen saturation targets (88 to 92%), 40 had higher targets (90 to 95%). The primary outcome was bronchopulmonary dysplasia (BPD). Secondary outcomes included duration of invasive/noninvasive respiratory support, oxygen therapy, and hospitalization. The primary outcome was compared using Fisher's exact test. Secondary outcomes were evaluated with survival analysis and Wilcoxon rank sum test. Results The difference in incidence of BPD in the lower (N=56, 53.3%) and higher saturation groups (N=14, 35.0%) was not statistically significant (relative risk [RR]=0.66 [0.41, 1.04], P=0.06). The difference in duration of mechanical ventilation in the lower (median 7.8 days, interquartile range [IQR] 3.7 to 15.9) and higher saturation groups (median 4.5, IQR 1.9 to 12.3) approached statistical significance (P=0.05). There were no statistically significant differences in the durations of other respiratory supports or hospital stay between the two groups. Conclusions The results of this study approached statistical significance and suggest that higher, narrower oxygen saturation targets may result in a clinically important reduction in BPD incidence and duration of mechanical ventilation. These results require validation in a larger sample to refine optimal targets.
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Affiliation(s)
- Youstina Hanna
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | | | - Nadya Ben Fadel
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Brigitte Lemyre
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Bernard Thébaud
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Nicholas Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Vid Bijelic
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Lynda Hoey
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Sherri L Katz
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
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13
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Petrou S, Yiu HH, Kwon J. Economic consequences of preterm birth: a systematic review of the recent literature (2009-2017). Arch Dis Child 2019; 104:456-465. [PMID: 30413489 DOI: 10.1136/archdischild-2018-315778] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite extensive knowledge on the functional, neurodevelopmental, behavioural and educational sequelae of preterm birth, relatively little is known about its economic consequences. OBJECTIVE To systematically review evidence around the economic consequences of preterm birth for the health services, for other sectors of the economy, for families and carers, and more broadly for society. METHODS Updating previous reviews, systematic searches of Medline, EconLit, Web of Science, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase and Scopus were performed using broad search terms, covering the literature from 1 January 2009 to 28 June 2017. Studies reporting economic consequences, published in the English language and conducted in a developed country were included. Economic consequences are presented in a descriptive manner according to study time horizon, cost category and differential denominators (live births or survivors). RESULTS Of 4384 unique articles retrieved, 43 articles met the inclusion criteria. Of these, 27 reported resource use or cost estimates associated with the initial period of hospitalisation, while 26 reported resource use or costs incurred following the initial hospital discharge, 10 of which also reported resource use or costs associated with the initial period of hospitalisation. Only two studies reported resource use or costs incurred throughout the childhood years. Initial hospitalisation costs varied between $576 972 (range $111 152-$576 972) per infant born at 24 weeks' gestation and $930 (range $930-$7114) per infant born at term (US$, 2015 prices). The review also revealed a consistent inverse association between gestational age at birth and economic costs regardless of date of publication, country of publication, underpinning study design, follow-up period, age of assessment or costing approach, and a paucity of evidence on non-healthcare costs. Several categories of economic costs, such as additional costs borne by families as a result of modifications to their everyday activities, are largely overlooked by this body of literature. Moreover, the number and coverage of economic assessments have not increased in comparison with previous review periods. CONCLUSION Evidence identified by this review can be used to inform clinical and budgetary service planning and act as data inputs into future economic evaluations of preventive or treatment interventions. Future research should focus particularly on valuing the economic consequences of preterm birth in adulthood.
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Affiliation(s)
- Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hei Hang Yiu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Joseph Kwon
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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14
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Zhou H, Roberts PA, Dhaliwal SS, Della PR. Risk factors associated with paediatric unplanned hospital readmissions: a systematic review. BMJ Open 2019; 9:e020554. [PMID: 30696664 PMCID: PMC6352831 DOI: 10.1136/bmjopen-2017-020554] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 09/21/2018] [Accepted: 10/23/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To synthesise evidence on risk factors associated with paediatric unplanned hospital readmissions (UHRs). DESIGN Systematic review. DATA SOURCE CINAHL, EMBASE (Ovid) and MEDLINE from 2000 to 2017. ELIGIBILITY CRITERIA Studies published in English with full-text access and focused on paediatric All-cause, Surgical procedure and General medical condition related UHRs were included. DATA EXTRACTION AND SYNTHESIS Characteristics of the included studies, examined variables and the statistically significant risk factors were extracted. Two reviewers independently assessed study quality based on six domains of potential bias. Pooling of extracted risk factors was not permitted due to heterogeneity of the included studies. Data were synthesised using content analysis and presented in narrative form. RESULTS Thirty-six significant risk factors were extracted from the 44 included studies and presented under three health condition groupings. For All-cause UHRs, ethnicity, comorbidity and type of health insurance were the most frequently cited factors. For Surgical procedure related UHRs, specific surgical procedures, comorbidity, length of stay (LOS), age, the American Society of Anaesthesiologists class, postoperative complications, duration of procedure, type of health insurance and illness severity were cited more frequently. The four most cited risk factors associated with General medical condition related UHRs were comorbidity, age, health service usage prior to the index admission and LOS. CONCLUSIONS This systematic review acknowledges the complexity of readmission risk prediction in paediatric populations. This review identified four risk factors across all three health condition groupings, namely comorbidity; public health insurance; longer LOS and patients<12 months or between 13-18 years. The identification of risk factors, however, depended on the variables examined by each of the included studies. Consideration should be taken into account when generalising reported risk factors to other institutions. This review highlights the need to develop a standardised set of measures to capture key hospital discharge variables that predict unplanned readmission among paediatric patients.
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Affiliation(s)
- Huaqiong Zhou
- General Surgical Ward, Princess Margret Hospital for Children, Perth, Western Australia, Australia
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Pam A Roberts
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | | | - Phillip R Della
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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15
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Kuint J, Lerner-Geva L, Chodick G, Boyko V, Shalev V, Reichman B. Type of Re-Hospitalization and Association with Neonatal Morbidities in Infants of Very Low Birth Weight. Neonatology 2019; 115:292-300. [PMID: 30808837 DOI: 10.1159/000495702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preterm infants are at high risk for long-term morbidities and an increased rate of re-hospitalization. OBJECTIVE The aim of this study was to evaluate the type of re-hospitalization of very low birth weight (VLBW) infants, from infancy through adolescence, and to assess the association of neonatal morbidities with specific types of re-hospitalization. STUDY DESIGN The study cohort comprised 6,385 VLBW infants who were registered with the Maccabi Healthcare Services (MHS) from their birth hospitalization. Data were collected for up to 18 years (median 10.7 years) following neonatal intensive care unit discharge. Hospitalization types were determined from the MHS coding. Neonatal morbidities included necrotizing enterocolitis (NEC), grades 3-4 intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were calculated using the Cox proportional hazards model. RESULTS Overall, 3,956 infants were re-hospitalized at least once and a total of 11,595 hospitalization types were identified. NEC, IVH, PVL, and BPD were associated with significantly higher aHRs for general pediatric (aHR 1.28-1.55), general surgical (aHR 1.18-1.46), and pediatric intensive care unit (aHR 1.57-2.04) hospitalizations. IVH and PVL were associated with significantly higher aHRs for orthopedic (aHR 2.12 and 4.88, respectively) and ophthalmology (1.76 and 4.02, respectively) hospitalizations. IVH was associated with a 14.2-fold higher aHR for neurosurgical admissions, and ROP with a 1.62-fold higher aHR for ophthalmology hospitalizations. CONCLUSION Among VLBW infants, specific patterns of re-hospitalization types associated with major neonatal morbidities were identified as particularly high risks for orthopedic and ophthalmology hospitalizations in infants with IVH and PVL, and for intensive care admissions in infants with NEC and BPD.
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Affiliation(s)
- Jacob Kuint
- Maccabitech, Maccabi Healthcare Services, Tel Aviv, Israel, .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
| | - Liat Lerner-Geva
- Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Chodick
- Maccabitech, Maccabi Healthcare Services, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Valentina Boyko
- Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Varda Shalev
- Maccabitech, Maccabi Healthcare Services, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brian Reichman
- Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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The Impact of Pulmonary Hypertension in Preterm Infants with Severe Bronchopulmonary Dysplasia through 1 Year. J Pediatr 2018; 203:218-224.e3. [PMID: 30172426 PMCID: PMC6460906 DOI: 10.1016/j.jpeds.2018.07.035] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/04/2018] [Accepted: 07/10/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the effect of pulmonary hypertension on neonatal intensive care unit mortality and hospital readmission through 1 year of corrected age in a large multicenter cohort of infants with severe bronchopulmonary dysplasia. STUDY DESIGN This was a multicenter, retrospective cohort study of 1677 infants born <32 weeks of gestation with severe bronchopulmonary dysplasia enrolled in the Children's Hospital Neonatal Consortium with records linked to the Pediatric Health Information System. RESULTS Pulmonary hypertension occurred in 370 out of 1677 (22%) infants. During the neonatal admission, pulmonary hypertension was associated with mortality (OR 3.15, 95% CI 2.10-4.73, P < .001), ventilator support at 36 weeks of postmenstrual age (60% vs 40%, P < .001), duration of ventilation (72 IQR 30-124 vs 41 IQR 17-74 days, P < .001), and higher respiratory severity score (3.6 IQR 0.4-7.0 vs 0.8 IQR 0.3-3.3, P < .001). At discharge, pulmonary hypertension was associated with tracheostomy (27% vs 9%, P < .001), supplemental oxygen use (84% vs 61%, P < .001), and tube feeds (80% vs 46%, P < .001). Through 1 year of corrected age, pulmonary hypertension was associated with increased frequency of readmission (incidence rate ratio [IRR] = 1.38, 95% CI 1.18-1.63, P < .001). CONCLUSIONS Infants with severe bronchopulmonary dysplasia-associated pulmonary hypertension have increased morbidity and mortality through 1 year of corrected age. This highlights the need for improved diagnostic practices and prospective studies evaluating treatments for this high-risk population.
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17
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Vohr B, McGowan E, Keszler L, O'Donnell M, Hawes K, Tucker R. Effects of a transition home program on preterm infant emergency room visits within 90 days of discharge. J Perinatol 2018; 38:185-190. [PMID: 28906495 DOI: 10.1038/jp.2017.136] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/06/2017] [Accepted: 06/08/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate effects of a transition home program (THP) and risk factors on emergency room (ER) use within 90 days of discharge for preterm (PT) infants <37 weeks gestation. STUDY DESIGN This is a prospective 3-year cohort study of 804 mothers and 954 PT infants. Mothers received enhanced neonatal intensive care unit transition support services until 90 days postdischarge. Regression models were run to identify the effects of THP implementation year and risk factors on ER visits. RESULTS Of the 954 infants, 181 (19%) had ER visits and 83/181 (46%) had an admission. In regression analysis, THP year 3 vs year 1 and human milk at discharge were associated with decreased risk of ER visits, whereas increased odds was associated with non-English speaking, maternal mental health disorders and bronchopulmonary dysplasia. CONCLUSION Enhanced THP services were associated with a 33% decreased risk of all ER visits by year 3. Social and environmental risk factors contribute to preventable ER visits.
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Affiliation(s)
- B Vohr
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA.,Alpert School of Medicine, Brown University, Providence, RI, USA
| | - E McGowan
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA.,Alpert School of Medicine, Brown University, Providence, RI, USA
| | - L Keszler
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA.,Alpert School of Medicine, Brown University, Providence, RI, USA
| | - M O'Donnell
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - K Hawes
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA.,Alpert School of Medicine, Brown University, Providence, RI, USA.,College of Nursing, University of Rhode Island, Kingston, RI, USA
| | - R Tucker
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA
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18
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Vohr B, McGowan E, Keszler L, Alksninis B, O'Donnell M, Hawes K, Tucker R. Impact of a Transition Home Program on Rehospitalization Rates of Preterm Infants. J Pediatr 2017; 181:86-92.e1. [PMID: 27817878 DOI: 10.1016/j.jpeds.2016.10.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/07/2016] [Accepted: 10/06/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To evaluate the effects of a transition home program on 90-day rehospitalization rates of preterm (PT) infants born at <37 weeks gestational age implemented over 3 years for infants with Medicaid and private insurance, and to identify the impact of social/environmental and medical risk factors on rehospitalization. STUDY DESIGN In this prospective cohort study of 954 early, moderate, and late PT infants, all families received comprehensive transition home services provided by social workers and family resource specialists (trained peers) working with the medical team. Rehospitalization data were obtained from a statewide database and parent reports. Group comparisons were made by insurance type. Regression models were run to identify factors associated with rehospitalization and duration of rehospitalization. RESULTS In bivariable analyses, Medicaid was associated with more infants hospitalized, more than 1 hospitalization, and more days of hospitalization. Early PT infants had more rehospitalizations by 90 days than moderate (P = .05) or late PT infants (P = .01). In regression modeling, year 3 of the transition home program vs year 1 was associated with a lower risk for rehospitalization by 90 days (OR, 0.57; 95% CI, 0.36-0.93; P = .03). Medicaid (P = .04), non-English-speaking (P = .02), multiple pregnancies (P = .05), and bronchopulmonary dysplasia (P = .001) were associated with increased risk. Both bronchopulmonary dysplasia and Medicaid were associated with increased days of rehospitalization in adjusted analyses. The major cause of rehospitalization was respiratory illness (61%). CONCLUSIONS Transition home prevention strategies must be directed at both social/environmental and medical risk factors to decrease the risk of rehospitalization.
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Affiliation(s)
- Betty Vohr
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI.
| | - Elisabeth McGowan
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI
| | - Lenore Keszler
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI
| | - Barbara Alksninis
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
| | - Melissa O'Donnell
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
| | - Katheleen Hawes
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI; College of Nursing, University of Rhode Island, Kingston, RI
| | - Richard Tucker
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
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19
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Neonates and Infants Discharged Home Dependent on Medical Technology: Characteristics and Outcomes. Adv Neonatal Care 2016; 16:379-389. [PMID: 27275531 DOI: 10.1097/anc.0000000000000314] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Preterm neonates and neonates with complex conditions admitted to a neonatal intensive care unit (NICU) may require medical technology (eg, supplemental oxygen, feeding tubes) for their continued survival at hospital discharge. Medical technology introduces another layer of complexity for parents, including specialized education about neonatal assessment and operation of technology. The transition home presents a challenge for parents and has been linked with greater healthcare utilization. PURPOSE To determine incidence, characteristics, and healthcare utilization outcomes (emergency room visits, rehospitalizations) of technology-dependent neonates and infants following initial discharge from the hospital. METHODS This descriptive, correlational study used retrospective medical record review to examine technology-dependent neonates (N = 71) upon discharge home. Study variables included demographic characteristics, hospital length of stay, and type of medical technology used. Analysis of neonates (n = 22) with 1-year postdischarge data was conducted to identify relationships with healthcare utilization. Descriptive and regression analyses were performed. FINDINGS Approximately 40% of the technology-dependent neonates were between 23 and 26 weeks' gestation, with birth weight of less than 1000 g. Technologies used most frequently were supplemental oxygen (66%) and feeding tubes (46.5%). The mean total hospital length of stay for technology-dependent versus nontechnology-dependent neonates was 108.6 and 25.7 days, respectively. Technology-dependent neonates who were female, with a gastrostomy tube, or with longer initial hospital length of stay were at greater risk for rehospitalization. IMPLICATIONS FOR PRACTICE Assessment and support of families, particularly mothers of technology-dependent neonates following initial hospital discharge, are vital. IMPLICATIONS FOR RESEARCH Longitudinal studies to determine factors affecting long-term outcomes of technology-dependent infants are needed.
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20
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Akter F, Coghlan G, de Mel A. Nitric oxide in paediatric respiratory disorders: novel interventions to address associated vascular phenomena? Ther Adv Cardiovasc Dis 2016; 10:256-70. [PMID: 27215618 DOI: 10.1177/1753944716649893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Nitric oxide (NO) has a significant role in modulating the respiratory system and is being exploited therapeutically. Neonatal respiratory failure can affect around 2% of all live births and is responsible for over one third of all neonatal mortality. Current treatment method with inhaled NO (iNO) has demonstrated great benefits to patients with persistent pulmonary hypertension, bronchopulmonary dysplasia and neonatal respiratory distress syndrome. However, it is not without its drawbacks, which include the need for patients to be attached to mechanical ventilators. Notably, there is also a lack of identification of subgroups amongst abovementioned patients, and homogeneity in powered studies associated with iNO, which is one of the limitations. There are significant developments in drug delivery methods and there is a need to look at alternative or supplementary methods of NO delivery that could reduce current concerns. The addition of NO-independent activators and stimulators, or drugs such as prostaglandins to work in synergy with NO donors might be beneficial. It is of interest to consider such delivery methods within the respiratory system, where controlled release of NO can be introduced whilst minimizing the production of harmful byproducts. This article reviews current therapeutic application of iNO and the state-of-the-art technology methods for sustained delivery of NO that may be adapted and developed to address respiratory disorders. We envisage this perspective would prompt active investigation of such systems for their potential clinical benefit.
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Affiliation(s)
- Farhana Akter
- UCL Centre for Nanotechnology and Regenerative Medicine; Division of Surgery and Interventional Science, UCL, UK
| | - Gerry Coghlan
- Pulmonary Hypertension Unit, Royal Free London NHS Foundation Trust, UK
| | - Achala de Mel
- Lecturer in Regenerative Medicine, UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London, Royal Free NHS Trust Hospital, 9th Floor, Room 355, Pond Street, London NW3 2QG, UK
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21
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Lee JH, Kim MJ, Kim YD, Lee SM, Song ES, Ahn SY, Kim CS, Lim JW, Chang M, Jin HS, Hwang JH, Lee WR, Chang YS. The Readmission of Preterm Infants of 30-33 Weeks Gestational Age within 1 Year Following Discharge from Neonatal Intensive Care Unit in Korea. NEONATAL MEDICINE 2014. [DOI: 10.5385/nm.2014.21.4.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jang Hoon Lee
- Department of Pediatrics, Ajou University Hospital, Suwon, Korea
| | - Myo Jing Kim
- Department of Pediatrics, Dong-A University Hospital, Busan, Korea
| | - Young Don Kim
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Eun Song Song
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Chun Soo Kim
- Department of Pediatrics, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jae Woo Lim
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea
| | - Meayoung Chang
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Hyun-Seung Jin
- Department of Pediatrics, Gangneung Asan Hospital, Gangneung, Korea
| | - Jong Hee Hwang
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Woo Ryoung Lee
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
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