Document Detail


Identification of extremely premature infants at high risk of rehospitalization.
MedLine Citation:
PMID:  22007016     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Extremely low birth weight infants often require rehospitalization during infancy. Our objective was to identify at the time of discharge which extremely low birth weight infants are at higher risk for rehospitalization.
METHODS: Data from extremely low birth weight infants in Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers from 2002-2005 were analyzed. The primary outcome was rehospitalization by the 18- to 22-month follow-up, and secondary outcome was rehospitalization for respiratory causes in the first year. Using variables and odds ratios identified by stepwise logistic regression, scoring systems were developed with scores proportional to odds ratios. Classification and regression-tree analysis was performed by recursive partitioning and automatic selection of optimal cutoff points of variables.
RESULTS: A total of 3787 infants were evaluated (mean ± SD birth weight: 787 ± 136 g; gestational age: 26 ± 2 weeks; 48% male, 42% black). Forty-five percent of the infants were rehospitalized by 18 to 22 months; 14.7% were rehospitalized for respiratory causes in the first year. Both regression models (area under the curve: 0.63) and classification and regression-tree models (mean misclassification rate: 40%-42%) were moderately accurate. Predictors for the primary outcome by regression were shunt surgery for hydrocephalus, hospital stay of >120 days for pulmonary reasons, necrotizing enterocolitis stage II or higher or spontaneous gastrointestinal perforation, higher fraction of inspired oxygen at 36 weeks, and male gender. By classification and regression-tree analysis, infants with hospital stays of >120 days for pulmonary reasons had a 66% rehospitalization rate compared with 42% without such a stay.
CONCLUSIONS: The scoring systems and classification and regression-tree analysis models identified infants at higher risk of rehospitalization and might assist planning for care after discharge.
Authors:
Namasivayam Ambalavanan; Waldemar A Carlo; Scott A McDonald; Qing Yao; Abhik Das; Rosemary D Higgins;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2011-10-17
Journal Detail:
Title:  Pediatrics     Volume:  128     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-02     Completed Date:  2012-01-24     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1216-25     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35249-7335, USA. ambal@uab.edu
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MeSH Terms
Descriptor/Qualifier:
Databases, Factual
Female
Follow-Up Studies
Gestational Age
Hospitalization / statistics & numerical data
Humans
Incidence
Infant
Infant, Extremely Low Birth Weight*
Infant, Newborn
Infant, Newborn, Diseases / diagnosis,  epidemiology*,  therapy*
Logistic Models
Male
Odds Ratio
Patient Readmission / statistics & numerical data*
Predictive Value of Tests
Pregnancy
Regression Analysis
Respiratory Tract Diseases / diagnosis,  epidemiology,  therapy*
Retrospective Studies
Risk Assessment
Survival Analysis
Time Factors
United States
Grant Support
ID/Acronym/Agency:
KL2 RR24149/RR/NCRR NIH HHS; M01 RR125/RR/NCRR NIH HHS; M01 RR16587/RR/NCRR NIH HHS; M01 RR30/RR/NCRR NIH HHS; M01 RR32/RR/NCRR NIH HHS; M01 RR39/RR/NCRR NIH HHS; M01 RR44/RR/NCRR NIH HHS; M01 RR6022/RR/NCRR NIH HHS; M01 RR633/RR/NCRR NIH HHS; M01 RR70/RR/NCRR NIH HHS; M01 RR7122/RR/NCRR NIH HHS; M01 RR750/RR/NCRR NIH HHS; M01 RR80/RR/NCRR NIH HHS; M01 RR8084/RR/NCRR NIH HHS; R03 HD054420/HD/NICHD NIH HHS; U10 HD21364/HD/NICHD NIH HHS; U10 HD21373/HD/NICHD NIH HHS; U10 HD21385/HD/NICHD NIH HHS; U10 HD21397/HD/NICHD NIH HHS; U10 HD27851/HD/NICHD NIH HHS; U10 HD27853/HD/NICHD NIH HHS; U10 HD27856/HD/NICHD NIH HHS; U10 HD27871/HD/NICHD NIH HHS; U10 HD27880/HD/NICHD NIH HHS; U10 HD27904/HD/NICHD NIH HHS; U10 HD34216/HD/NICHD NIH HHS; U10 HD36790/HD/NICHD NIH HHS; U10 HD40461/HD/NICHD NIH HHS; U10 HD40492/HD/NICHD NIH HHS; U10 HD40498/HD/NICHD NIH HHS; U10 HD40521/HD/NICHD NIH HHS; U10 HD40689/HD/NICHD NIH HHS; UL1 RR024160/RR/NCRR NIH HHS; UL1 RR24139/RR/NCRR NIH HHS; UL1 RR24148/RR/NCRR NIH HHS; UL1 RR24160/RR/NCRR NIH HHS
Investigator
Investigator/Affiliation:
Barbara J Stoll / ; Edward F Bell / ; Michele C Walsh / ; Seetha Shankaran / ; Abbot R Laptook / ; Rosemary D Higgins / ; Abhik Das / ; Nancy S Newman / ; Ellen C Hale / ; Betty R Vohr / ; Anna M Dusick / ; Patricia W Evans / ; Myriam Peralta-Carcelen / ; Michael J Acarregui / ; Roy J Heyne / ; Kimberly Yolton / ; Abhik Das / ; Rosemary D Higgins / ; Alan H Jobe / ; Michael S Caplan / ; Abbot R Laptook / ; William Oh / ; Betty R Vohr / ; Angelita Hensman / ; Theresa M Leach / ; Martha R Leonard / ; James R Moore / ; Lucy Noel / ; Bonnie E Stephens / ; Robert Burke / ; Yvette Yatchmink / ; Rachel V Walden / ; Victoria E Watson / ; Michele C Walsh / ; Avroy A Fanaroff / ; Deanne Wilson-Costello / ; Nancy S Newman / ; Bonnie S Siner / ; Kurt Schibler / ; Edward F Donovan / ; Jean J Steichen / ; Kate Bridges / ; Barbara Alexander / ; Cathy Grisby / ; Marcia Worley Mersmann / ; Holly L Mincey / ; Jody Hessling / ; Teresa L Gratton / ; Ronald N Goldberg / ; C Michael Cotten / ; Ricki F Goldstein / ; Kathy J Auten / ; Kimberley A Fisher / ; Melody B Lohmeyer / ; Barbara J Stoll / ; David P Carlton / ; Ira Adams-Chapman / ; Ellen C Hale / ; Linda L Wright / ; Elizabeth M McClure / ; Brenda B Poindexter / ; James A Lemons / ; Anna M Dusick / ; Diana D Appel / ; Dianne E Herron / ; Lucy C Miller / ; Leslie Dawn Wilson / ; W Kenneth Poole / ; Betty Hastings / ; Elizabeth N McClure / ; Jamie E Newman / ; Jeanette O'Donnell Auman / ; Carolyn M Petrie Huitema / ; Kristin M Zaterka-Baxter / ; Krisa P Van Meurs / ; Susan R Hintz / ; David K Stevenson / ; M Bethany Ball / ; Joan M Baran / ; Lori E Bond / ; Ginger K Brudos / ; S Davis / ; Anne M DeBattista / ; Barry E Fleisher / ; Jean G Kohn / ; Julie C Lee-Ancajas / ; Renee P Pyle / ; Dharshi Sivakumar / ; Nicholas H St John / ; Myriam Peralta-Carcelen / ; Monica V Collins / ; Shirley S Cosby / ; Vivien A Phillips / ; Neil N Finer / ; Yvonne E Vaucher / ; Maynard R Rasmussen / ; David Kaegi / ; Kathy Arnell / ; Clarence Demetrio / ; Martha G Fuller / ; Chris Henderson / ; Wade Rich / ; Charles R Bauer / ; Shahnaz Duara / ; Silvia Hiriart-Fajardo / ; Ruth Everett-Thomas / ; Mary Allison / ; Alexis N Diaz / ; Silvia Frade Eguaras / ; Yamiley C Gideon / ; Arielle Riguard / ; Alexandra Stoerger / ; Andrea Garcia / ; Helina Pierre / ; Kasey Hamlin-Smith / ; Dale L Phelps / ; Gary J Myers / ; Linda J Reubens / ; Mary Rowan / ; Erica Burnell / ; Diane Hust / ; Rosemary L Jensen / ; Lauren Zwetsch / ; Julie Babish Johnson / ; Emily Kushner / ; Joan Merzbach / ; Kelly Yost / ; Walid A Salhab / ; Pablo J Sánchez / ; Charles R Rosenfeld / ; Abbot R Laptook / ; Roy J Heyne / ; Sally S Adams / ; Cristin Dooley / ; Alicia Guzman / ; Gaynelle Hensley / ; Jackie F Hickman / ; Linda A Madden / ; Susie Madison / ; Nancy A Miller / ; Janet S Morgan / ; Catherine Twell Boatman / ; Elizabeth Heyne / ; Kathleen A Kennedy / ; Jon E Tyson / ; Brenda H Morris / ; Pamela J Bradt / ; Patricia W Evans / ; Esther G Akpa / ; Nora I Alaniz / ; Patty A Cluff / ; Maegan Currence / ; Claudia I Franco / ; Anna E Lis / ; Georgia E McDavid / ; Patti L Pierce Tate / ; Laura L Whiteley / ; Sharon L Wright / ; T Michael O'Shea / ; Lisa K Washburn / ; Robert G Dillard / ; Nancy J Peters / ; Barbara G Jackson / ; Korinne Chiu / ; Deborah Evans Allred / ; Donald J Goldstein / ; Raquel Halfond / ; Carroll Peterson / ; Ellen L Waldrep / ; Melissa Whalen Morris / ; Gail Wiley Hounshell / ; Seetha Shankaran / ; Yvette R Johnson / ; Athina Pappas / ; Rebecca Bara / ; Geraldine Muran / ; Deborah Kennedy / ; Laura A Goldston / ; Richard A Ehrenkranz / ; Patricia Gettner / ; Harris C Jacobs / ; Christine Butler / ; Patricia Cervone / ; Monica Konstantino / ; Elaine Romano / ; JoAnn Poulsen / ; Janet Taft / ; Joanne Williams / ; Sheila Greisman /
Comments/Corrections

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