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Early term delivery and health care utilization in the first year of life
Patricia M Dietz1, Joanne H Rizzo, Lucinda J England
1Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Insights
Early term infants born between 37-38 weeks gestation used more healthcare in their first year. This included longer hospital stays and more sick/emergency room visits compared to full-term infants.
Area of Science:
- Neonatal Health
- Pediatric Healthcare Utilization
- Perinatal Medicine
Background:
- Infants born at 37-38 weeks gestation are considered early term.
- Understanding their healthcare needs is crucial for optimizing care.
- Previous studies have not fully elucidated healthcare utilization patterns in this population.
Purpose of the Study:
- To assess and compare healthcare utilization in the first year of life for early term-born infants versus those born at 39-40 weeks gestation.
- To identify specific areas of increased healthcare use, such as hospitalizations and emergency visits.
Main Methods:
- Retrospective cohort study of 22,420 singleton term infants (37-42 weeks gestational age).
- Data collected from electronic medical records for healthcare utilization up to 12 months post-delivery.
- Logistic and generalized linear models used to analyze associations between gestational age and healthcare utilization metrics.
Main Results:
- 20.9% of term infants were born early (37-38 weeks gestation).
- Infants born at 37 weeks gestation had significantly higher odds of prolonged delivery hospitalization and rehospitalization within 2 weeks.
- Early term infants (37-38 weeks) had a higher adjusted mean number of sick/emergency room visits compared to those born at 39-40 weeks.
Conclusions:
- Early term birth is associated with increased healthcare utilization throughout the first year of life.
- Infants born at 37-38 weeks gestation require more healthcare resources compared to those born at 39-40 weeks.
- These findings highlight the need for tailored healthcare monitoring and support for early term infants.
Objective:
To assess health care utilization during the first year of life among early term-born infants.
Study Design:
We assessed health care utilization of 22420 singleton term infants (37-42 weeks gestational age [GA]) without major birth defects, fetal growth restriction, or exposure to diabetes or hypertension in utero, delivered between 1998 and 2007 and continuously enrolled at Kaiser Permanente Northwest for 12 months after delivery. GA, duration of delivery hospitalization, and postdelivery rehospitalizations and sick/emergency room visits in the first year of life were obtained from electronic medical records. Logistic regression models were used to estimate associations between GA and number of hospitalizations and length of stay. Generalized linear models were used to estimate the adjusted mean number of sick/emergency visits.
Results:
Overall, 20.9% of term infants were born early. Infants delivered vaginally at 37 weeks GA had a 2.2 greater odds (95% CI, 1.6-3.1) of staying 4 or more days compared with those born at 39-40 weeks GA. Similar association was found among infants delivered by cesarean delivery at 37 or 38 weeks GA. Infants born at 37 weeks GA had increased odds of being rehospitalized within 2 weeks of delivery (OR, 2.6; 95% CI, 1.9-3.6). The adjusted mean number of sick/emergency room visits was higher for infants born at 37 and 38 weeks GA than for those born at 39-40 weeks GA (8.1, 7.7, and 7.3, respectively; P < .0001).
Conclusions:
Early term-born infants had greater health care utilization during their entire first year of life than infants born at 39-40 weeks GA.
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