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Konzett K, Riedl D, Blassnig-Ezeh A, Gang S, Simma B. Outcome in very preterm infants: a population-based study from a regional center in Austria. Front Pediatr 2024; 12:1336469. [PMID: 38370138 PMCID: PMC10873957 DOI: 10.3389/fped.2024.1336469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Aim To determine short-term morbidity and mortality rates in the first state-wide Austrian neonatal cohort and comparison to (inter)national data. Methods Observational, population-based cohort study, analyzing data of preterm infants (<32 + 0 weeks of gestation) born between 2007 and 2020 (n = 501) in an Austrian state who were admitted to the neonatal intensive care unit. Outcome criteria were mortality, neonatal morbidities: bronchopulmonary dysplasia (BPD), severe necrotizing enterocolitis (NEC), severe intraventricular hemorrhage (IVH grades III-IV), severe retinopathy of prematurity (ROP grades III-V) and survival-free of major complications. Results Overall survival rate was 95%, survival free of major complications was 79%. Prevalence for BPD was 11.2%, surgical NEC 4.0%, severe IVH 4.6%, and for severe ROP 2.6%, respectively. In the extremely low gestational age neonates (ELGAN) born <28 weeks of gestation (n = 158), survival was 88% and survival free of major complications 58.8%. Over time, mortality decreased significantly, predominantly driven by the improvement of infants born <28 week of gestation and survival free of major complications improved. Conclusions This study demonstrates a very low mortality rate that decreases over time. Short-term morbidities and survival free of major complications do not differ from (inter)national data in a similar group of very preterm infants. Standard operating procedures, simulation trainings and accordance to international trials may improve patient care and surpass center case loads.
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Affiliation(s)
- Karin Konzett
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - David Riedl
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Innsbruck, Austria
| | - Anya Blassnig-Ezeh
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Stefanie Gang
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Burkhard Simma
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
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Vaz LE, Wagner DV, Jungbauer RM, Ramsey KL, Jenisch C, Koskela-Staples N, Everist S, Austin JP, Harris MA, Zuckerman KE. The Role of Caregiver-Reported Risks in Predicting Adverse Pediatric Outcomes. J Pediatr Psychol 2020; 45:957-970. [PMID: 32815539 PMCID: PMC8312731 DOI: 10.1093/jpepsy/jsaa067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Certain social risk factors (e.g., housing instability, food insecurity) have been shown to directly and indirectly influence pediatric health outcomes; however, there is limited understanding of which social factors are most salient for children admitted to the hospital. This study examines how caregiver-reported social and medical characteristics of children experiencing an inpatient admission are associated with the presence of future health complications. METHODS Caregivers of children experiencing an inpatient admission (N = 249) completed a predischarge questionnaire designed to capture medical and social risk factors across systems (e.g., patient, caregiver, family, community, healthcare environment). Electronic health record (EHR) data were reviewed for child demographic data, chronic disease status, and subsequent emergency department visits or readmissions (i.e., acute events) 90 days postindex hospitalization. Associations between risk factors and event presence were estimated using odds ratios (ORs) and confidence intervals (CI), both unadjusted and adjusted OR (aOR) for chronic disease and age. RESULTS Thirty-three percent (N = 82) of children experienced at least one event. After accounting for child age and chronic disease status, caregiver perceptions of child's health being generally "poor" or "not good" prior to discharge (aOR = 4.7, 95% CI = 2.3, 9.7), having high care coordination needs (aOR = 3.2, 95% CI = 1.6, 6.1), and experiencing difficulty accessing care coordination (aOR = 2.5, 95% CI = 1.4, 4.7) were significantly associated with return events. CONCLUSIONS Caregiver report of risks may provide valuable information above and beyond EHR records to both determine risk of future health problems and inform intervention development.
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Affiliation(s)
- Louise E Vaz
- Department of Pediatrics, Doernbecher Children’s Hospital
| | - David V Wagner
- Department of Pediatrics, Doernbecher Children’s Hospital
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-Based Practice Center, Oregon Health
& Science University
| | - Katrina L Ramsey
- Biostatistics and Design Program, Oregon Health & Science
University
| | | | | | - Steven Everist
- Department of Pediatrics, Doernbecher Children’s Hospital
- BUILD EXITO Program, Portland State University
| | - Jared P Austin
- Department of Pediatrics, Doernbecher Children’s Hospital
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Adetunji O, Ottino K, Tucker A, Al-Attar G, Abduljabbar M, Bishai D. Variations in pediatric hospitalization in seven European countries. Health Policy 2020; 124:1165-1173. [PMID: 32739031 DOI: 10.1016/j.healthpol.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare rates of pediatric hospital utilization across seven European countries. METHODS Secondary data from WHO's European Hospital Morbidity Database from 2009 to 2012. Cross- country comparison of rates of admissions and bed days per 100 person-years by clinical service. We tabulated counts of admissions and bed days by principal diagnosis and age group for Ireland, Austria, Hungary, Belgium, Spain, Germany, and France. ICD 9 or ICD 10 or ISHMT diagnosis codes were allocated to clinical services. Normal newborn admissions were excluded from the analysis. Simple linear regression models, weighted by pediatric population size, were constructed to estimate the relationships between health care utilization and factors that may influence variation in care. RESULTS Hospital admission across the seven countries ranged from 9.41 (Spain) to 19.59 (Germany) admissions per 100 person-years. Bed days ranged from a low of 52.50 (Spain) to 135.44 (Germany) per 100 person-years. General pediatrics and neonatology led in clinical volume across all countries. Infectious disease admissions were the third most common. Bed supply and nurse supply were positively associated with health care utilization. Out-of-pocket payment was inversely associated with health care utilization CONCLUSIONS: A wide range of utilization of pediatric inpatient care was observed across seven European countries that have universal coverage. Variation in the provision of effective, supply-sensitive, and preference-sensitive care may explain some of the variations. Our study shows that it is probable that preventable hospital admissions are occurring in the pediatric population.
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Affiliation(s)
- Oluwarantimi Adetunji
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
| | - Kevin Ottino
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
| | - Austin Tucker
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
| | | | | | - David Bishai
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States.
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Abstract
Readmission amongst previous neonatal intensive care unit (NICU) graduates, especially for preterm infants, is common and remains a significant risk for these infants beyond the neonatal period. This review explores risk factors for readmissions, common reasons for requiring rehospitalization and explores opportunities for improving the transition from discharge to home with the ultimate goal of reducing readmissions for these high risk infants.
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Affiliation(s)
- Kathleen E Hannan
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Neonatology MS 8402, 13121 E. 17th Ave., Aurora, CO 80045, United States.
| | - Sunah S Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Neonatology MS 8402, 13121 E. 17th Ave., Aurora, CO 80045, United States
| | - Stephanie L Bourque
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Neonatology MS 8402, 13121 E. 17th Ave., Aurora, CO 80045, United States
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Lee LK, Burns RA, Dhamrait RS, Carter HF, Vadi MG, Grogan TR, Elashoff DA, Applegate RL, Iravani M. Retrospective Cohort Study on the Optimal Timing of Orogastric Tube/Nasogastric Tube Insertion in Infants With Pyloric Stenosis. Anesth Analg 2019; 129:1079-1086. [DOI: 10.1213/ane.0000000000003805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wehrmeister FC, Victora CG, Horta BL, Menezes AMB, Santos IS, Bertoldi AD, da Silva BGC, Barros FC. Hospital admissions in the first year of life: inequalities over three decades in a southern Brazilian city. Int J Epidemiol 2019; 48:i63-i71. [PMID: 30883660 PMCID: PMC6422058 DOI: 10.1093/ije/dyy228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hospital admissions in infancy are declining in several countries. We describe admissions to neonatal intensive care units (NICU) and other hospitalizations over a 33-year period in the Brazilian city of Pelotas. METHODS We analysed data from four population-based birth cohorts launched in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. NICU and other hospital admissions during infancy were reported by the mothers in the perinatal interview and at the 12-month visit, respectively. We describe these outcomes by sex of the child, family income and maternal skin colour. RESULTS In 1982, NICUs did not exist in the city; admissions into NICUs increased from 2.7% of all newborns in 1993 to 6.7% in 2015, and admission rates were similar in all income groups. Hospitalizations during the first year of life fell by 29%, from 23.7% in 1982 to 16.8% in 2015, and diarrhoea admissions fell by 95.2%. Pneumonia admissions fell by 46.3% from 1993 to 2015 (no data available for 1982). Admissions due to perinatal causes increased during the period. In the poorest income quintile, total admissions fell by 33% (from 35.7% to 23.9%), but in the richest quintile these remained stable at around 10%, leading to a reduction in inequalities. Over the whole period, children born to women with black or brown skin were 30% more likely to be admitted than those of white-skinned mothers. CONCLUSIONS Whereas NICU admissions increased, total admissions in the first year of life declined by nearly one-third. Socioeconomic disparities were reduced, but important gaps remain.
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Affiliation(s)
| | - Cesar G Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Bruna G C da Silva
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
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Abstract
There are numerous measures of perinatal quality endorsed by national agencies such as the National Quality Forum (NQF). The sheer number of metrics may lead to confusion about what these measures truly assess, and how to interpret variation in these measures across hospitals, health care systems, and geographic regions. This review presents a conceptual model for the numerous validated measures, an overview of the types of measures endorsed for perinatal quality by NQF in 2016, and potential measures absent from endorsement by these national bodies.
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Affiliation(s)
- Scott A Lorch
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, 2716 South Street, Room 10-251, Philadelphia, PA 19146, USA; PolicyLab, The Children's Hospital of Philadelphia, 2716 South Street, Room 10-251, Philadelphia, PA 19146, USA; Center for Perinatal and Pediatric Health Disparities Research, The Children's Hospital of Philadelphia, 2716 South Street, Room 10-251, Philadelphia, PA 19146, USA; Department of Pediatrics, The University of Pennsylvania School of Medicine, 2716 South Street, Room 10-251, Philadelphia, PA 19146, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, USA.
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Enlow E, Faherty LJ, Wallace-Keeshen S, Martin AE, Shea JA, Lorch SA. Perspectives of Low Socioeconomic Status Mothers of Premature Infants. Pediatrics 2017; 139:peds.2016-2310. [PMID: 28223372 PMCID: PMC5330396 DOI: 10.1542/peds.2016-2310] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Transitioning premature infants from the NICU to home is a high-risk period with potential for compromised care. Parental stress is high, and families of low socioeconomic status may face additional challenges. Home visiting programs have been used to help this transition, with mixed success. We sought to understand the experiences of at-risk families during this transition to inform interventions. METHODS Mothers of infants born at <35 weeks' gestation, meeting low socioeconomic status criteria, were interviewed by telephone 30 days after discharge to assess caregiver experiences of discharge and perceptions of home visitors (HVs). We generated salient themes by using grounded theory and the constant comparative method. Interviews were conducted until thematic saturation was achieved. RESULTS Twenty-seven mothers completed interviews. Eighty-five percent were black, and 81% had Medicaid insurance. Concern about infants' health and fragility was the primary theme identified, with mothers reporting substantial stress going from a highly monitored NICU to an unmonitored home. Issues with trust and informational consistency were mentioned frequently and could threaten mothers' willingness to engage with providers. Strong family networks and determination compensated for limited economic resources, although many felt isolated. Mothers appreciated HVs' ability to address infant health but preferred nurses over lay health workers. CONCLUSIONS Low-income mothers experience significant anxiety about the transition from the NICU to home. Families value HVs who are trustworthy and have relevant medical knowledge about prematurity. Interventions to improve transition would benefit by incorporating parental input and facilitating trust and consistency in communication.
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Affiliation(s)
- Elizabeth Enlow
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; .,Division of Neonatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; and
| | - Laura J. Faherty
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; and,Robert Wood Johnson Foundation Clinical Scholars Program
| | | | - Ashley E Martin
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Judy A. Shea
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; and,Division of General and Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott A. Lorch
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Division of Neonatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;,Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania; and
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Peltz A, Wu CL, White ML, Wilson KM, Lorch SA, Thurm C, Hall M, Berry JG. Characteristics of Rural Children Admitted to Pediatric Hospitals. Pediatrics 2016; 137:peds.2015-3156. [PMID: 27244794 PMCID: PMC4845869 DOI: 10.1542/peds.2015-3156] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Delivering high-quality care to children living in rural areas can be challenging. Compared with nonrural children, rural children often experience worse health outcomes. We assessed characteristics and hospitalizations of rural children admitted to US children's hospitals in 2012. METHODS Retrospective cohort analysis of 672190 admissions between January 1, 2012, and December 31, 2012, to 41 children's hospitals in the Pediatric Health Information System database. ZIP codes were used to assess the patients' rurality (by using Rural-Urban Community Areas classification), residence in a Health Professional Shortage Area, and family income. Multivariable regression was used to compare patient characteristics and hospital utilization between rural and nonrural children. RESULTS Rural children accounted for 12% of all admissions (n = 81 360) to the children's hospitals. Compared with nonrural children, rural children lived farther from the hospital (median [interquartile range]: 68 [48-104] vs 12 [6-24] miles) and more often resided in low-income ZIP codes (53% vs 24%) and Health Professional Shortage Areas (20% vs 4%) (P < .001 for all). Rural children had a higher prevalence of complex chronic conditions (44% vs 37%; P < .001) and medical technology assistance (15% vs 12%; P < .001). In multivariable analysis, rural children experienced higher inpatient costs (mean: $8507 vs $7814; P < .001) and higher odds of 30-day readmission (odds ratio: 1.1; 95% confidence interval: 1.0-1.1; P < .001). CONCLUSIONS Rural children hospitalized at children's hospitals have high rates of medical complexity and often reside in low-income and medically underserved areas. Compared with nonrural children, rural children experience more expensive hospitalizations and more frequent readmissions.
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Affiliation(s)
- Alon Peltz
- Robert Wood Johnson Foundation Clinical Scholars Program, Yale University, New Haven, Connecticut; Department of Pediatrics, Boston Medical Center, Boston, Massachusetts;
| | - Chang L. Wu
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marjorie Lee White
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karen M. Wilson
- Department of Pediatrics, University of Colorado School of Medicine, Section of Hospital Medicine, Children’s Hospital Colorado, Aurora, CO
| | - Scott A. Lorch
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cary Thurm
- Children’s Hospital Association, Overland Park, Kansas
| | - Matt Hall
- Children’s Hospital Association, Overland Park, Kansas
| | - Jay G. Berry
- Division of General Pediatrics, Harvard Medical School, Boston, Massachusetts; and,Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
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Schiltz NK, Rosenthal BF, Crowley MA, Koroukian SM, Nevar A, Meropol SB, Cuttler L. Rehospitalization during the first year of life by insurance status. Clin Pediatr (Phila) 2014; 53:845-53. [PMID: 24899633 PMCID: PMC4412744 DOI: 10.1177/0009922814536924] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the association of insurance status on infant rehospitalization in a population-based setting. METHODS In this longitudinal retrospective study, hospitalizations were tracked for 1 year after birth discharge for 203 031 infants born in hospitals during 2008 using data from the New York State Inpatient Database. Relative risk was estimated using multivariable negative binomial regression models. RESULTS Rehospitalization occurred in 9010 infants (4.4%). Medicaid coverage and being uninsured were strong predictors of rehospitalizations after adjustment for birth weight and other factors. Medicaid also bears a disproportionate share of the economic burden. Normal birth weight infants have the lowest risk, but comprise the majority of costs. Jaundice and acute bronchiolitis were the leading causes of rehospitalization within 30 days and 1 year, respectively. DISCUSSION Future research can explore the preventability of rehospitalizations, and evaluate novel strategies for discharge and postnatal care coordination especially for uninsured and Medicaid-enrolled infants.
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Affiliation(s)
- Nicholas K. Schiltz
- Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, OH
,The Center for Child Health & Policy, Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Beth Finkelstein Rosenthal
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH
,The Center for Child Health & Policy, Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Moira A. Crowley
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH
,The Center for Child Health & Policy, Rainbow Babies and Children’s Hospital, Cleveland, OH
,The Division of Neonatology, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Siran M. Koroukian
- Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, OH
| | - Ann Nevar
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH
,The Center for Child Health & Policy, Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Sharon B. Meropol
- Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, OH
,Department of Pediatrics, Case Western Reserve University, Cleveland, OH
,The Center for Child Health & Policy, Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Leona Cuttler
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH
,The Center for Child Health & Policy, Rainbow Babies and Children’s Hospital, Cleveland, OH
,The Division of Endocrinology, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
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