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Published on: December 31, 2015
Continuing utilisation of specialised health services in extremely preterm infants
1Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada. thuy.mai.luu@umontreal.ca
Insights
Extremely preterm infants born at 23-25 weeks experienced higher re-hospitalization rates and greater healthcare resource utilization by 18 months corrected age compared to those born at 26-28 weeks. This highlights the need for targeted support for vulnerable preterm infants.
Area of Science:
- Neonatal Medicine
- Pediatric Healthcare
- Public Health
Background:
- Extremely preterm infants (born <28 weeks gestation) represent a vulnerable population with significant healthcare needs post-discharge.
- Understanding healthcare utilization patterns is crucial for effective resource allocation and optimizing outcomes for these infants.
Purpose of the Study:
- To compare healthcare use from neonatal discharge to 18 months corrected age (CA) between two groups of extremely preterm neonates: those born at 23-25 weeks gestation and those born at 26-28 weeks gestation.
- To identify factors associated with re-hospitalization and high outpatient healthcare service use in extremely preterm infants.
Main Methods:
- A cohort study was conducted involving 254 infants born at or before 28 weeks gestation across three Canadian hospital centers.
- Healthcare use, including re-hospitalization, therapy, rehabilitation programs, medication, and assistive devices, was assessed from neonatal discharge to 18 months corrected age.
Main Results:
- Infants born at 23-25 weeks had higher re-hospitalization rates (57%) compared to those born at 26-28 weeks (49%).
- By 18 months CA, the 23-25 week group showed increased use of physical/occupational therapy (61% vs 59%), long-term rehabilitation (29% vs 17%), prescribed medication (38% vs 28%), and medical assistive devices (59% vs 33%).
- Risk factors for re-hospitalization included bronchopulmonary dysplasia (BPD), severe brain injury, home oxygen use, and older discharge age. Multiple births, BPD, severe brain injury, older discharge age, and single parenthood were linked to higher outpatient service use.
Conclusions:
- Extremely preterm infants exhibit substantial healthcare resource utilization and frequent re-hospitalization during infancy.
- Findings underscore the critical need for adequate resource allocation for medical and rehabilitation services for preterm infants following neonatal intensive care unit discharge.
Objective:
To compare healthcare use from neonatal discharge to 18 months corrected age (CA) of two groups of extremely preterm neonates (23-25 vs 26-28 weeks).
Design:
Cohort study.
Patients:
Infants born at < or =28 weeks and admitted in three hospital centres in Quebec, Canada (n=254).
Main Outcome Measures:
Neurodevelopmental outcomes and healthcare use from neonatal discharge to 18 months CA.
Results:
Re-hospitalisation rates occurred in 57% of children born at 23-25 weeks and in 49% of those born at 26-28 weeks. In these two age groups, by 18 months, 61% vs 59% were followed in physical or occupational therapy, 29% vs 17% were enrolled in a long-term rehabilitation program, 38% vs 28% used prescribed medication, and 59% vs 33% required medical assistive devices, respectively. Risk of re-hospitalisation was related to bronchopulmonary dysplasia (BPD), severe brain injury, use of home oxygen or an apnoea monitor and older age at neonatal discharge. Multiple births, BPD, severe brain injury, older age at neonatal discharge and single parenthood were associated with risk of using out-patient health services above average (>2 services).
Conclusion:
Extremely preterm children are frequently re-hospitalised during infancy and use a substantial amount of healthcare resources. These results highlight the importance of resource allocation to preterm infants for medical and rehabilitation services after discharge from the neonatal intensive care unit.
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