Related Experiment Videos
Mortality and morbidity in high risk infants during a six year follow-up
S Chaudhari1, S Kulkarni, A Pandit
1Department of Pediatrics, K.E.M. Hospital, Pune 411 011, India.
Insights
High-risk infants face elevated mortality and rehospitalization post-discharge. Regular High Risk Clinic (HRC) attendance significantly reduces these risks, while borderline intelligence affects 14.6% by age six.
Area of Science:
- Neonatal care
- Pediatric follow-up studies
- High-risk infant outcomes
Background:
- Infants discharged from Neonatal Special Care Units (NSCU) often require ongoing monitoring.
- Predetermined risk criteria are used to identify infants needing specialized follow-up.
- Post-discharge outcomes for high-risk infants are critical to understand.
Purpose of the Study:
- To investigate mortality and morbidity in high-risk infants after hospital discharge.
- To assess the impact of High Risk Clinic (HRC) attendance on infant outcomes.
- To evaluate long-term neurodevelopmental outcomes at six years of age.
Main Methods:
- Prospective study with a 6-year follow-up period.
- Enrollment of 404 high-risk infants and 86 controls.
- Utilized home visits, verbal autopsies, and assessments using Bayley Scales and Stanford-Binet Scale.
Main Results:
- Mortality was significantly higher in very low birth weight (VLBW) infants.
- Regular HRC attendance correlated with lower mortality (6.4%) versus defaulters (27.6%).
- High-risk infants showed increased rehospitalization (95 vs. 2) and borderline intelligence (14.6% vs. 5.6%).
Conclusions:
- High-risk infants experience substantial post-discharge mortality and rehospitalization.
- Consistent engagement with High Risk Clinics is crucial for improving infant survival and health.
- A significant proportion of high-risk children develop borderline intelligence by age six, even with seemingly normal earlier development.
Objective:
To study the mortality and morbidity in high risk infants after discharge from the hospital.
Design:
Prospective, 6 year follow up.
Setting:
High Risk Clinic (HRC).
Methods:
Infants discharged from a Neonatal Special Care Unit were identified for follow up using predetermined risk criteria. Home visits were made by the social worker, if appointments to HRC were missed. Verbal autopsy was performed in case of home deaths. Intercurrent illnesses and rehospitalizations were recorded. At six years, the children who had come for the final assessment at 30 months on the Bayley Scales, were recalled for assessment of the intelligence quotient, by Stanford-Binet Scale.
Results:
Four hundred and four high risk infants and eighty six controls were enrolled. There were 40 deaths in the study period, out of which 38 occurred in the first year of life, sixty per cent of these occurring in the first three months. The mortality was significantly higher in the VLBW group. Out of the 22 hospital deaths, 72.7% were due to infection. There was a significant difference (p < 0.001) in the mortality rate between the group which attended the HRC regularly (6.4%) as compared to that of the defaulters (27.6%). Ninety five children had rehospitalization in the High Risk group as compared to two in the control group (p < 0.001). In the 286 children who were assessed at 6 years, the incidence of borderline intelligence was 14.6% as compared to 5.6% in the controls (p < 0.05).
Conclusion:
Mortality and rehospitalization rate is high in high risk infants, after discharge from the hospital. Children who appear to have normal development in the third year, may show a high incidence (14.6%) of borderline intelligence at six years.