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Very-low-birth-weight infant short-term post-discharge outcomes: A retrospective study of specialized compared to
Karen Lasby1, Tammy Sherrow2, Tanis Fenton3
1Neonatal Transition Team, Postpartum Community Services, Alberta Health Services, Calgary, AB, Canada. karen.lasby@albertahealthservices.ca.
Insights
Specialized follow-up care for very low birth weight infants improved breast milk intake but increased emergency visits and hospitalizations, except for those needing long-term oxygen. This highlights a trade-off in post-discharge care strategies.
Area of Science:
- Neonatal care
- Pediatric health outcomes
- Infant nutrition
Background:
- Very low birth weight (VLBW) infants face significant health challenges post-discharge, including poor breast milk intake and frequent rehospitalizations.
- Optimizing care for VLBW infants during their first year is crucial for reducing healthcare burdens and improving long-term outcomes.
Purpose of the Study:
- To compare the effects of specialized vs. standard post-discharge follow-up care on breast milk intake, growth, emergency department (ED) visits, and rehospitalizations in VLBW infants.
- To identify specific care strategies that enhance health outcomes for VLBW infants after hospital discharge.
Main Methods:
- A retrospective cohort study comparing 150 VLBW infants receiving specialized care in western Canada with 205 VLBW infants receiving standard care in central Canada.
- Logistic regression and generalized estimating equations were used to analyze differences in breast milk intake, growth, ED visits, and non-surgical rehospitalizations between the two groups.
Main Results:
- Specialized care significantly increased the duration of breast milk intake, with a six-fold higher likelihood of intake at 4 months compared to standard care.
- Infants in the specialized care group had more ED visits and rehospitalizations overall.
- However, for VLBW infants requiring oxygen beyond 36 weeks, specialized care did not increase rehospitalization risk, unlike standard care which showed a seven-fold increase.
Conclusions:
- Specialized neonatal nursing follow-up supports continued breast milk intake post-discharge.
- While specialized care led to increased healthcare utilization (ED visits, hospitalizations), it mitigated rehospitalization risks for VLBW infants with prolonged oxygen dependency.
- These findings suggest a nuanced approach to specialized follow-up care, balancing benefits of enhanced nutrition with potential increases in healthcare resource use.
Objective:
Ongoing health care challenges, low breast milk intake, and the need for rehospitalization are common during the first year of life after hospital discharge for very low birth weight (VLBW) infants. This retrospective cohort study examined breast milk intake, growth, emergency department (ED) visits, and non-surgical rehospitalizations for VLBW infants who received specialized post-discharge follow-up in western Canada, compared to VLBW infants who received standard follow-up in central Canada.
Design:
Data were collected from two neonatal follow-up programs for VLBW babies (n = 150 specialized-care; n = 205 standard-care). Logistic regression was used to examine odds of breast milk intake and generalized estimating equations were used for odds of growth, ED visits and non-surgical rehospitalization by site.
Results:
Specialized-care was associated with enhanced breast milk intake duration; the odds of receiving breastmilk at 4 months in the specialized-care cohort was 6 times that in the standard-care cohort. The specialized-care cohort had significantly more ED visits and rehospitalizations. However, for infants with oxygen use beyond 36 weeks compared to those with no oxygen use, the standard-care cohort had over 7 times the odds of rehospitalization where as the specialized-care cohort with no increased odds of rehospitalization.
Conclusion:
Specialized neonatal nursing follow-up was associated with continued breastmilk intake beyond discharge. Infants in the specialized-care cohort used the ED and were hospitalized more often than the standard-care cohort with the exception of infants with long term oxygen needs.
