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Composite neonatal morbidity indicators using hospital discharge data: A systematic review
Elodie Lebreton1,2,3, Catherine Crenn-Hébert3,4, Claudie Menguy3,5
1Data Science and Analytics Department, SESAN, Paris, France.
Insights
Defining neonatal morbidity is crucial for research, but current indicators lack standardization. This review highlights the need for consistent outcome measures to improve comparisons and synthesis of findings on infant health.
Area of Science:
- Neonatal research
- Public health surveillance
- Healthcare informatics
Background:
- Neonatal morbidity significantly impacts long-term health outcomes.
- Lack of a standardized definition and large datasets hinder research progress.
- Composite neonatal morbidity indicators from hospital discharge data are underutilized.
Purpose of the Study:
- To review composite neonatal morbidity indicators derived from routine hospital discharge data.
- To inform initiatives for defining standard research outcomes.
- To identify heterogeneity in current indicators and guide future standardization efforts.
Main Methods:
- Systematic literature search of PubMed using keywords: "morbidity," "neonatal," and "hospital discharge data."
- Inclusion criteria: studies using composite indicators from hospital discharge data, excluding condition-specific indicators.
- Data extraction: target population, objectives, component morbidities, codes, validation methods, and prevalence.
Main Results:
- Seventeen studies met inclusion criteria, focusing on all infants, low-/moderate-risk, or very preterm (VPT) infants.
- Indicator components and diagnosis codes showed significant variation, especially for all and low-/moderate-risk infants.
- Prevalence rates varied widely: 4.6%-9.0% (all), 0.4%-8.0% (low-/moderate-risk), and 17.8%-61.0% (VPT).
Conclusions:
- Existing neonatal morbidity indicators derived from hospital discharge data are heterogeneous, limiting inter-study comparisons.
- There is a critical need for standardized neonatal outcome measures for effective benchmarking and research synthesis.
- Standardization will enhance the reliability and comparability of research on neonatal health outcomes.
Background:
Neonatal morbidity is associated with lifelong impairments, but the absence of a consensual definition and the need for large data sets limit research.
Objectives:
To inform initiatives to define standard outcomes for research, we reviewed composite neonatal morbidity indicators derived from routine hospital discharge data.
Data Sources:
PubMed (updated on October 12, 2018). The search algorithm was based on three components: "morbidity," "neonatal," and "hospital discharge data."
Study Selection And Data Extraction:
Studies investigating neonatal morbidity using a composite indicator based on hospital discharge data were included. Indicators defined for specific conditions (eg congenital anomalies, maternal addictions) were excluded. The target population, objectives, component morbidities, diagnosis and procedure codes, validation methods, and prevalence of morbidity were extracted.
Synthesis:
For each study, we assessed construct validity by describing the methods used to select the indicator components and evaluated whether the authors assessed internal and external validity. We also calculated confidence intervals for the prevalence of the morbidity composite.
Results:
Seventeen studies fulfilled inclusion criteria. Indicators targeted all (n = 4), low-/moderate-risk (n = 9), and very preterm (VPT, n = 4) infants. Components were similar for VPT infants, but domains and diagnosis codes within domains varied widely for all and low-/moderate-risk infants. Component selection was described for 8/17 indicators and some form of validation reported for 12/17. Neonatal morbidity prevalence ranged from 4.6% to 9.0% of all infants, 0.4% to 8.0% of low-/moderate-risk infants, and 17.8% to 61.0% of VPT infants.
Conclusions:
Multiple neonatal morbidity indicators based on hospital discharge data have been used for research, but their heterogeneity limits comparisons between studies. Standard neonatal outcome measures are needed for benchmarking and synthesis of research results.
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