Rehospitalization in the first 2 years of life in children born preterm

Aim: Aim of the study is to investigate the frequency of and predictors for rehospitalization within the first 2 years of life among preterm infants. Methods: All children born before 32 weeks of gestation in Northern Tyrol between January 2003 and July 2008 were prospectively enrolled. Data on rehospitalizations were obtained from hospital admission records. The association between candidate risk factors and readmission was analysed by means of logistic regression analysis. Results: In the first and second years of life, 151 and 93 of 377 children (40.1% and 24.7%), respectively, were readmitted to one of the hospitals in Northern Tyrol. The most common causes of rehospitalization were respiratory disorders, accounting for 42.1% and 47.4% of total readmissions in the first and second years of life. Chronic lung disease (CLD), male sex and smoking in pregnancy were risk conditions relevant to readmission in the first year of life, but only CLD in the second year. Conclusion: Infants born before 32 weeks of gestation have a high risk of rehospitalization with respiratory illness significantly contributing to postdischarge morbidity. Neonatal intensive care should aim to further improve respiratory health in preterm infants, and adequate follow‐up services must be offered.     

Rehospitalization in the first year of life among infants with bronchopulmonary dysplasia

OBJECTIVE: To describe rates and identify risk factors for rehospitalization during the first year of life among infants with bronchopulmonary dysplasia (BPD). STUDY DESIGN: This was a retrospective cohort study of infants born at a gestational age (GA) <33 weeks, between 1995 and 1999. BPD was defined as requirement of supplemental oxygen and/or mechanical ventilation at 36 weeks' corrected GA. The outcome was rehospitalization for any reason before first birthday. RESULTS: In the first year of life, 118 of 238 (49%) infants with BPD were rehospitalized, more than twice the rate of rehospitalization of the non-BPD population, which was 309 of 1359 (23%) (P=<.0001). No measured factor discriminated between those infants with BPD who were and were not rehospitalized, even when only rehospitalizations for respiratory diagnoses were considered. CONCLUSIONS: Among premature infants, BPD substantially increases the risk of rehospitalization during the first year of life. Neither demographic nor physiologic factors predicted rehospitalization among the infants with BPD. Other factors, such as air quality of home environment, passive smoking exposure, respiratory syncytial virus prophylaxis, breast-feeding status, and/or parenting and primary care management styles, should be examined in future studies.     

Sleep/wake patterns of breast-fed infants in the first 2 years of life

Published norms for infant sleep/wake patterns during the first 2 years of life include an increase in length of maximum sleep bout from four to five to eight to ten hours by 4 months but little decrease in total sleep in 24 hours from 13 to 15 hours. Thirty-two breast-fed infants were followed for 2 years and data collected on 24-hour patterns of nursing and sleep. Infants who were breast-fed into the second year did not develop sleep/wake patterns in conformance with the norms. Instead of having long unbroken night sleep, they continued to sleep in short bouts with frequent wakings. Their total sleep in 24 hours was less than that of weaned infants. This pattern was most pronounced in infants who both nursed and shared a bed with the mother, common practices in many nonwestern cultures. The sleep/wake development accepted as the physiologic norm may be attributable to the early weaning and separated sleeping practiced in western culture. As prolonged breast-feeding becomes more popular in our society, the norms of sleep/wake patterns in infancy will have to be revised.     

Rehospitalization of very preterm infants in the first year of life. Comparison of 2 groups: 1997 and 2002]

OBJECTIVE: The aim of the study was to compare the rehospitalization rate in the first year of life between 2 groups of very preterm infants born on 1997 and 2002; then we compared the very preterm infants' rehospitalization rate between our retrospective 1997 group and literature (including French cohort Epipage). PATIENTS AND METHODS: Our retrospective study included all neonates born相似文献   

Rehospitalization of very-low-birth-weight infants

Very-low-birth-weight (VLBW) infants are at high risk of mortality, morbidity, and rehospitalization in the first years of life, but little information is available to predict which VLBW infants are likely to require rehospitalization. This study describes a sample of 79 VLBW infants cared for in a charity hospital. The sample was predominantly black, and the majority of the mothers were young and unmarried. Some of the infants were followed up by a multidisciplinary High-Risk Follow-up Clinic, and all were tracked until their second birthdays to determine the rate of rehospitalization. Using multiple regression, we present herein a model that accounts for 51% of the variance in rehospitalization; the model includes mother's age, education, and marital status; infant birth weight and gestational age; the use of prenatal care and the High-Risk Follow-up Clinic; and three quadratic terms. Although the significance of the quadratic factors in the model makes explanation of these results difficult, results suggest that the model can be used to predict whether infants will require rehospitalization in the first two years of life.     

Growth of Hong Kong infants during the first two years of life

Physical growth in weight, length and head circumference during infancy and early childhood (the first two years) of Hong Kong children born in the 1960's and 1970's have been compared with a widely used international reference standard (National Center for Health Statistics). During the first 3-6 months the mean growth curves closely follow the reference mean. Over the following 6-12 months however, there is a distinct downward deviation. From about 18 months onwards the growth trajectories once again closely parallel the reference. This 'faltering' of physical growth, which shows some similarities with that described by young children in poor parts of the world has been attributed by some to less than adequate nutrition during the weaning period. Yet over the past 20 years or so Hong Kong has very much become part of the developed world. This apparent paradox leads us to speculate that genetic influences might play an important role in the faltering of growth.     

Risk factors for retinochoroiditis during the first 2 years of life in infants with treated congenital toxoplasmosis

BACKGROUND: Retinochoroiditis is the main complication of congenital toxoplasmosis. Its risk factors have rarely been investigated and were the object of this study. METHODS: A retrospective study was conducted on 300 infants with congenital toxoplasmosis born between July 1, 1996 and December 31, 2002 and treated with pyrimethamine and sulfonamide for at least 12 months. Results of eye tests were collected up to 24 months. Risk factors associated with first retinochoroiditis were identified by univariate then multivariate analyses (Cox model). RESULTS: One hundred forty-nine boys and 151 girls were included. Maternal infection dated from the first trimester in 34 cases, the second in 97 cases, and the last in 169 cases. At birth, 22 infants had cerebral calcifications. During the first 2 years of life, first retinochoroiditis was diagnosed in 36 infants (12%).In multivariate analysis, 3 factors were significantly associated with first retinochoroiditis before the age of 2 years: a delay of >8 weeks between maternal seroconversion and first treatment [hazard ratio, 2.54; 95% confidence interval (CI), 1.14-5.65], female gender (hazard ratio, 2.02; 95% CI, 1.01-4.1), and cerebral calcifications at birth (hazard ratio, 4.3; 95% CI, 1.9-10). There was no correlation between gestational age at the time of maternal infection and risk for retinochoroiditis. CONCLUSIONS: A delay of >8 weeks between maternal seroconversion and the beginning of treatment, female gender, and especially cerebral calcifications are risk factors for retinochoroiditis during the first 2 years of life in infants treated for congenital toxoplasmosis.     

Rehospitalization of very preterm infants

Rehospitalization rates of very preterm infants because of reasons that are related to neonatal morbidity states can be decreased with further improvement of neonatal intensive care provided.

Conclusion: Analysis of rehospitalization data should be included in follow-up programmes as a contribution to the development of strategies to improve neonatal care and the ultimate outcome for very-low-birthweight infants.     

Stability of neurocranial signs in the first two years of life in infants at risk

Background

Acknowledgement of low-severity/high-prevalence disabilities in infants born preterm singles out the need to identify early markers of brain impairments which could predict these late emergent disabilities. The neurological status as assessed by the Amiel-Tison Neurological Assessments (ATNA) has been proposed as one such potential marker. However, the stability of the ATNA has never been formally assessed.

Aim

This study aimed to assess the stability of the ATNA.

Study design

A total of 89 infants born preterm with a gestational age ranging from 29 0/7 to 37 0/7 weeks inclusively and a birth weight below 2500 g were followed during their first two years of life (term age, 4, 8, 12 and 24 months corrected age) in a clinical context.

Results

Of these, 62 children (69.7%) were classified in the same category on the five assessments while 14 (15.7%) had only one divergent result and 13 (14.6%) had two divergent results over the follow-up. The neurological status throughout the assessments remains stable according to Cochran's Q.

Conclusion

As the neurological status identified by the ATNA remained stable throughout repeated measurements in a regular clinical context and has been shown to correlate with later developmental performances, it should be included as a criterion to target children at risk and used during follow-up.     

Health service utilisation of a regional cohort of very preterm infants over the first 2 years of life

AIM: Very preterm infants represent major consumers of health services following neonatal discharge. We examined the health service utilisation of a regional cohort of very preterm infants over the first 2 years of life, including the association with neurodevelopmental outcome. METHODS: A regionally based 2-year cohort of 100 very preterm infants along with a comparison sample of 104 full term control infants matched for sex, time and place of birth were recruited. Perinatal and social background factors that predispose very preterm infants to increased risk of subsequent general practitioner (GP) and hospital service use were identified. At 2 years, all children underwent a neurodevelopmental assessment, Bayley Scales of Infant Development (BSID-II). Details of children's medical contacts obtained by parent interview were cross-checked against GP and hospital records/databases. RESULTS: Very preterm infants had a similar number of GP visits to term infants but more outpatient hospital visits. Fifty-three (55%) very preterm infants were admitted to hospital on 131 occasions compared with 26 (26%) term infants on 37 occasions (p<0.001). The main reason for hospitalisation in the preterm cohort was respiratory disorder. The frequency of hospital admissions was significantly related to birthweight (P=0.01), gestational age (P<0.001) and the number of people living in the family household (P=0.02). No associations were found between hospital admission and neurodevelopment at 2 years. CONCLUSION: Very preterm infants had higher rates of hospital admissions and visits than term infants unrelated to neurodevelopmental outcome at 2 years of age. These findings highlight that very preterm birth is associated with ongoing health morbidity.     

Evaluation of neonatal intensive care for extremely-low-birth-weight infants

Neonatal intensive care for extremely-low-birth-weight (ELBW, 500-999 g) infants must be evaluated to determine that it is effective, efficient, and available to those who need it. From the late 1970s until the late 1990s in the state of Victoria, Australia, neonatal intensive care has been increasingly effective, with large increases in the long-term survival rate from 25% in 1979-1980 to 73% in 1997, and in the quality-adjusted survival rate from 19% to 59% over the same time. Its efficiency has been relatively high and stable over time, comparing favourably with many other health-care programmes. It is increasingly available, with fewer than 10% of ELBW infants born outside level III perinatal centres in the latest era, and proportionally more ELBW infants being offered intensive care over time. Neonatal intensive care should be re-evaluated at intervals in the future to ensure that its effectiveness, efficiency and availability are maintained.     

Growth and neurodevelopmental outcome in extremely-low-birth-weight infants after laparotomy

Twenty-one extremely-low-birth-weight (ELBW) and premature infants (<29 weeks' gestation and/or <1,000 g) underwent emergency laparotomy for acute intra-abdominal pathology (necrotising enterocolitis [NEC] 16, other bowel pathology 5) during the 4-year period from 1990 to 1993; 11 died. The neurodevelopmental outcome of the 10 survivors was assessed and compared with 20 living, otherwise normal controls matched for gestational age, birth weight, and year of birth to asses the effect of the abdominal event on quality of survival. Those who survived after laparotomy had a worse neurodevelopmental outcome than controls (P < 0.05). During this period, we also compared 24 infants in the ELBW category who developed NEC but did not require a laparotomy with the 16 ELBW infants with NEC who required a laparotomy. Those who required a laparotomy had worse disease and had significantly worse neurodevelopmental outcomes (P < 0.01). ELBW and premature infants who have acute intra-abdominal pathology requiring a laparotomy are thus at increased risk of neurodevelopmental problems and poor growth. Close long-term follow-up is important, and the families of such infants should be made aware before surgery of the increased risk the abdominal event has on their babies' developmental outcome if they survive. Accepted 18 November 1999