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Neonatal Morbidities and Hospitalization in the First 2 Years of Life Among Infants Born Very Preterm
Tim J van Hasselt1, Rebecca A Dorner2, Anup Katheria2
1Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom.
Insights
Most children born very preterm require hospitalization before age two. Lower gestational age and neonatal morbidities, such as bronchopulmonary dysplasia, significantly increase hospital days for these vulnerable infants.
Area of Science:
- Neonatal Medicine
- Pediatric Healthcare Research
Background:
- Children born very preterm (less than 32 weeks' gestation) have higher healthcare utilization.
- Contemporary national data on hospitalizations post-neonatal discharge for this population is limited, hindering family counseling and healthcare planning.
Purpose of the Study:
- To quantify hospital admissions in children born very preterm from neonatal discharge up to two years of age.
- To assess the association between these hospitalizations and common neonatal morbidities.
Main Methods:
- Retrospective cohort study utilizing linked national databases from England and Wales (National Neonatal Research Database, Hospital Episode Statistics, Patient Episode Database).
- Included children born between 22-31 weeks' gestation from 2013-2018.
- Analyzed factors including gestational age, sex, small-for-gestational-age status, discharge season, and neonatal morbidities (bronchopulmonary dysplasia, necrotizing enterocolitis, brain injury).
Main Results:
- 67.2% of 39,413 very preterm infants were hospitalized before age two.
- Hospitalization rates increased with lower gestational age, from 58.8% for 31-weekers to 87.0% for <24-weekers.
- Neonatal morbidities significantly increased total hospitalization days: bronchopulmonary dysplasia (AIRR 1.80), severe necrotizing enterocolitis (AIRR 1.88), and neonatal brain injury (AIRR 1.46).
- Infants born <24 weeks' gestation with three morbidities were estimated to have 40.6 hospitalization days before age two.
Conclusions:
- The majority of very preterm infants experience hospitalizations post-neonatal discharge, with duration linked to gestational age and neonatal morbidities.
- Findings support the need for improved family counseling and targeted interventions to reduce hospitalizations in this high-risk group.
- Further research into preventative strategies for hospitalization in very preterm infants is warranted.
Importance:
Children born very preterm have increased health care use. However, there is a lack of research using contemporary national data quantifying hospitalizations after neonatal discharge to inform counseling of families and health care provision.
Objective:
To examine hospital admissions after neonatal discharge and before 2 years of age among children born at less than 32 weeks' gestation and assess associations between hospitalization and neonatal morbidities.
Design, Setting, And Participants:
This retrospective cohort study used data from all neonatal units and admitting hospitals in England and Wales supplied from the National Neonatal Research Database, linked with the Hospital Episode Statistics Admitted Patient Care database in England and the Patient Episode Database for Wales. Participants were children born at 22 through 31 weeks' gestation from January 1, 2013, to December 31, 2018, who were admitted to neonatal units and discharged home. Analysis was performed from June 26, 2024, to June 3, 2025.
Exposures:
Gestational age; sex; small-for-gestational-age status; season at time of neonatal discharge; neonatal morbidities, including bronchopulmonary dysplasia (BPD), severe necrotizing enterocolitis (NEC), and neonatal brain injury; and number of morbidities.
Main Outcomes And Measures:
Prevalence of hospital admission and total calendar days hospitalized across all admissions. Negative binomial regression was used to calculate the adjusted incidence rate ratio (AIRR) for total calendar days hospitalized, adjusting for gestational age, sex, small for gestational age, and season of neonatal discharge.
Results:
Among the 39 413 children included (21 360 [54.2%] male; median gestational age at birth, 29 weeks [IQR, 27-31 weeks]), 26 276 (66.7%) did not have major neonatal morbidities. A total of 26 498 children (67.2%) had at least 1 episode of hospitalization between neonatal discharge and the age of 2 years. This ranged from 6138 of 10 444 children born at 31 weeks' gestation (58.8%) to 450 of 517 born at less than 24 weeks (87.0%). The median number of total calendar days hospitalized across admissions increased from 1 day (IQR, 0-5 days) for children born at 31 weeks' gestation to 8 days (IQR, 3-21 days) for those born at less than 24 weeks. Neonatal morbidities were associated with increased total days hospitalized; the AIRR for total hospitalization days for children with vs without BPD was 1.80 (95% CI, 1.72-1.88), for those with vs without severe NEC was 1.88 (95% CI, 1.65-2.15), and for those with vs without neonatal brain injury was 1.46 (95% CI, 1.36-1.57). Combinations of morbidities were associated with total expected days hospitalized: the model estimated that a child born at less than 24 weeks' gestation with 3 morbidities would have 40.6 days (95% CI, 34.8-44.3 days) of hospitalization before age 2 years.
Conclusions And Relevance:
In this cohort study of children born very preterm discharged from neonatal care in England and Wales, most children experienced hospitalization before their second birthday, and hospitalizations were associated with lower gestational age and neonatal morbidities. These findings can aid counseling and suggest that further research should investigate interventions to prevent hospitalization in this population.
