J Korean Med Sci.  2015 Oct;30(Suppl 1):S95-S103. 10.3346/jkms.2015.30.S1.S95.

Use of Medical Resources by Preterm Infants Born at Less than 33 Weeks' Gestation Following Discharge from the Neonatal Intensive Care Unit in Korea

• Lee JH
• Chang YS
• Committee on Data Collection and Statistical Analysis, the Korean Society of Neonatology

• KMID: 2351142
• DOI: http://doi.org/10.3346/jkms.2015.30.S1.S95

Abstract

This study was aimed to provide data on the use of medical resources by preterm infants following discharge from the neonatal intensive care unit (NICU). The cohort included preterm infants (n=2,351) born at 22-32 weeks' gestation who were discharged from the NICUs of 44 Korean hospitals between April 2009 to March 2010. Mean duration of post-discharge follow-up was 425+/-237 days. After discharge from the NICU, 94.5% of total infants visited a pediatric outpatient clinic (11.5+/-9.8 mean visits), 42.9% visited a pediatric clinic for respiratory problems irregularly (4.9+/-6.6 mean visits), and 31.1% utilized emergency center at least once. Among all visits to the emergency center, 24.7% resulted in readmission and 50.8% of those visits were due to respiratory problems. At least one episode of readmission was required by 33.6% (788/2,346) of total infants, and 18.4% (431/2,346) of total infants were readmitted with respiratory problems at least once. Among all infants readmitted for respiratory problems, 16.2% (70/341) were diagnosed with respiratory syncytial virus infection which accounted for 30.3% of viral etiologies confirmed by laboratory testing. Infants born at <30 weeks' gestation had more frequent total readmission and respiratory readmission than those > or =30 weeks' gestation (2+/-1.7 vs. 1.7+/-1.2, P=0.009, 1.8+/-1.2 vs. 1.5+/-1.1, 0.027, respectively). Overall, use of medical resources is common, and respiratory problems are the leading cause of use of medical resources. Total readmissions and respiratory readmissions are more frequent in more immature infants.

Keyword

Infant, Premature; Patient Readmission; Outpatient Clinics; Hospital; Emergency Service, Respiratory Problems

MeSH Terms

Cohort Studies
Databases, Factual
Emergency Service, Hospital
Female
Follow-Up Studies
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases/*pathology
Intensive Care Units, Neonatal
Male
Patient Readmission
Republic of Korea
Respiratory Distress Syndrome, Newborn/*pathology
Retrospective Studies

Figure

• 

  Fig. 1 Study population. Among 2,698 infants born at 22-32 weeks' gestation discharged from the neonatal intensive care unit of 44 Korean hospitals between April 2009 to March 2010, 2,373 infants survived. Excluding 21 infants with incomplete data, 2,35l infants were enrolled.

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  Fig. 2 Cumulative percent of follow-up duration of preterm infants after discharge from the neonatal intensive care unit (NICU). Mean value and standard deviation of the duration was 425±237 days.

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  Fig. 3 Days to first readmission following discharge from the neonatal intensive care unit (NICU). The younger the gestational age at birth, the higher the probability of total readmissions and readmissions for respiratory problems (log-rank test for trend P < 0.001). Kaplan-Meier curves are shown for total readmission (A) and readmission for respiratory problems (B). *Means a significantly higher probability of readmissions following discharge from the NICU, compared with infants 30-31, and 32 weeks' gestation (Pair-wise comparison, P < 0.05).

Reference

1. Wilson-Costello D, Friedman H, Minich N, Fanaroff AA, Hack M. Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants in the 1990s. Pediatrics. 2005; 115:997–1003.

2. Petrou S, Sach T, Davidson L. The long-term costs of preterm birth and low birth weight: results of a systematic review. Child Care Health Dev. 2001; 27:97–115.

3. Underwood MA, Danielsen B, Gilbert WM. Cost, causes and rates of rehospitalization of preterm infants. J Perinatol. 2007; 27:614–619.

4. Ralser E, Mueller W, Haberland C, Fink FM, Gutenberger KH, Strobl R, Kiechl-Kohlendorfer U. Rehospitalization in the first 2 years of life in children born preterm. Acta Paediatr. 2012; 101:e1–e5.

5. Rhein LM, Konnikova L, McGeachey A, Pruchniewski M, Smith VC. The role of pulmonary follow-up in reducing health care utilization in infants with bronchopulmonary dysplasia. Clin Pediatr (Phila). 2012; 51:645–650.

6. Petrou S, Mehta Z, Hockley C, Cook-Mozaffari P, Henderson J, Goldacre M. The impact of preterm birth on hospital inpatient admissions and costs during the first 5 years of life. Pediatrics. 2003; 112:1290–1297.

7. Chien YH, Tsao PN, Chou HC, Tang JR, Tsou KI. Rehospitalization of extremely-low-birth-weight infants in first 2 years of life. Early Hum Dev. 2002; 66:33–40.

8. Heo YH, Lee YJ, Lee WS, Chung SH, Choi YS, Lee KS, Chang JY, Bae CW. Survival outcome of neonatal intensive care units in Korea by gestational age (2002-2009). J Korean Soc Neonatol. 2012; 19:134–139.

9. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001; 163:1723–1729.

10. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986; 33:179–201.

11. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978; 92:529–534.

12. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988; 16:128–140.

13. Resch B, Pasnocht A, Gusenleitner W, Müller W. Rehospitalisations for respiratory disease and respiratory syncytial virus infection in preterm infants of 29-36 weeks gestational age. J Infect. 2005; 50:397–403.

14. Park HW, Lee BS, Kim AR, Yoon HS, Kim BI, Song ES, Kim WT, Lim J, Kim S, Jin HS, et al. Epidemiology of respiratory syncytial virus infection in infants born at less than thirty-five weeks of gestational age. Pediatr Infect Dis J. 2012; 31:e99–e104.

15. Chang SG, Park MS, Yu JE. Outcomes of palivizumab prophylaxis for respiratory syncytial virus infection in preterm children with bronchopulmonary dysplasia at a single hospital in Korea from 2005 to 2009. J Korean Med Sci. 2010; 25:251–256.

16. Park SK, Jung YJ, Yoo HS, Ahn SY, Seo HJ, Choi SH, Kim MJ, Jeon GW, Koo SH, Lee KH, et al. Effect of Synagis® (palivizumab) prophylaxis on readmission due to respiratory syncytial virus in very low birth weight infants. Korean J Pediatr. 2010; 53:358–363.

17. Kim SJ, Chae SH, Lee JH, Kim YJ, Koo SH, Jeon GW, Chang YS, Park WS. Rehospitalization of very low birth weight infants in the first year after discharge from NICU and risk factor of rehospitalization caused by respiratory illness. J Korean Soc Neonatol. 2006; 13:17–23.

18. Groothuis JR, Gutierrez KM, Lauer BA. Respiratory syncytial virus infection in children with bronchopulmonary dysplasia. Pediatrics. 1988; 82:199–203.

19. Groothuis JR, Simoes EA, Hemming VG. Respiratory Syncytial Virus Immune Globulin Study Group. Respiratory syncytial virus (RSV) infection in preterm infants and the protective effects of RSV immune globulin (RSVIG). Pediatrics. 1995; 95:463–467.

20. The PREVENT Study Group. Reduction of respiratory syncytial virus hospitalization among premature infants and infants with bronchopulmonary dysplasia using respiratory syncytial virus immune globulin prophylaxis. Pediatrics. 1997; 99:93–99.

21. Wang EE, Law BJ, Robinson JL, Dobson S, al Jumaah S, Stephens D, Boucher FD, McDonald J, Mitchell I, MacDonald NE. PICNIC (Pediatric Investigators Collaborative Network on Infections in Canada) study of the role of age and respiratory syncytial virus neutralizing antibody on respiratory syncytial virus illness in patients with underlying heart or lung disease. Pediatrics. 1997; 99:E9.

22. Nachman SA, Navaie-Waliser M, Qureshi MZ. Rehospitalization with respiratory syncytial virus after neonatal intensive care unit discharge: A 3-year follow-up. Pediatrics. 1997; 100:E8.

23. Carbonell-Estrany X, Quero J, Bustos G, Cotero A, Doménech E, Figueras-Aloy J, Fraga JM, García LG, García-Alix A, Del Río MG, et al. IRIS Study Group. Rehospitalization because of respiratory syncytial virus infection in premature infants younger than 33 weeks of gestation: a prospective study. Pediatr Infect Dis J. 2000; 19:592–597.

24. Carbonell-Estrany X, Quero J. IRIS Study Group. Hospitalization rates for respiratory syncytial virus infection in premature infants born during two consecutive seasons. Pediatr Infect Dis J. 2001; 20:874–879.

25. Pedraz C, Carbonell-Estrany X, Figueras-Aloy J, Quero J. IRIS Study Group. Effect of palivizumab prophylaxis in decreasing respiratory syncytial virus hospitalizations in premature infants. Pediatr Infect Dis J. 2003; 22:823–827.

26. Joffe S, Escobar GJ, Black SB, Armstrong MA, Lieu TA. Rehospitalization for respiratory syncytial virus among premature infants. Pediatrics. 1999; 104:894–899.

27. Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. Pediatrics. 1998; 102:531–537.

28. Parnes C, Guillermin J, Habersang R, Nicholes P, Chawla V, Kelly T, Fishbein J, McRae P, Goessler M, Gatti A, et al. Palivizumab prophylaxis of respiratory syncytial virus disease in 2000-2001: results from The Palivizumab Outcomes Registry. Pediatr Pulmonol. 2003; 35:484–489.

29. Oh PI, Lanctôt KL, Yoon A, Lee DS, Paes BA, Simmons BS, Parison D, Manzi P. Composs Investigators. Palivizumab prophylaxis for respiratory syncytial virus in Canada: utilization and outcomes. Pediatr Infect Dis J. 2002; 21:512–518.

30. Drysdale SB, Alcazar-Paris M, Wilson T, Smith M, Zuckerman M, Peacock JL, Johnston SL, Greenough A. Viral lower respiratory tract infections and preterm infants' healthcare utilisation. Eur J Pediatr. 2015; 174:209–215.

31. Gray D, Woodward LJ, Spencer C, Inder TE, Austin NC. Health service utilisation of a regional cohort of very preterm infants over the first 2 years of life. J Paediatr Child Health. 2006; 42:377–383.

32. Korvenranta E, Lehtonen L, Peltola M, Häkkinen U, Andersson S, Gissler M, Hallman M, Leipälä J, Rautava L, Tammela O, et al. Morbidities and hospital resource use during the first 3 years of life among very preterm infants. Pediatrics. 2009; 124:128–134.