The Duration of Hospitalization and Readmission Rate of Low Birth Weight Infants in a Tertiary Referral Hospital in Isfahan, Iran

Document Type : Original Article

Authors

1 Assistant Professor, Division of Neonatology, Department of Pediatrics, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 General Practitioner, Almahdi University, Isfahan, Iran

4 Faculty Member, Department of Epidemiology & Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Currently, the number of premature deliveries has been increasing, resulting in early postnatal discharge due to shortage of beds in the neonatal intensive care units (NICU).
Methods: This descriptive-analytical study was conducted through investigating the premature infants’ files for gestational age (GA), birth weight (BW) and duration of the first hospitalization. Furthermore, the readmission rate during the first year of life and their causes were studied.
Results: Overall, 495 infants were enrolled in this study. The range of GA and BW of infants who were admitted to NICU were 24-36 weeks and 470 - 2500 g, respectively. A total of 172 (34.74%) infants had a BW of less than 1500 g (VLBW), and 144 of them (29.09%) were severely premature (GA of between 24-31 weeks). The median (range) time of hospitalization in VLBW infants was 22 (1-75). Moreover, 76 (15.3%) infants were re-hospitalized during the first year of life, and 32 (6.4%) infants were readmitted during the first three months of life. The four most common causes of re-hospitalization during the first year of life were as follows: pneumonia (32.89%), icter (17.10%), treatment of retinopathy of prematurity (10.52%) and sepsis (9.20%).
Conclusion: Hospital policies are changing due to the high rate of preterm births and lack of neonatal beds. The results of this study suggested that premature neonates, who are able to regulate body temperature at room temperature, and gain weight by oral feeding with no recent apnoea or bradycardia, could be discharged regardless of their gestational age and body weight.

Keywords


  1. Seki K, Iwasaki S, An H, Horiguchi H, Mori M, Nishimaki S, et al. Early discharge from a neonatal intensive care unit and rates of readmission. Pediatr Int. 2011; 53(1):7-12.
  2. Health and Welfare and Statistics Association. Ministry of Health, Labour and Welfare of Japan (Vital statistics). Tokyo: Health and Welfare and Statistics Association; 1997.
  3. Health and Welfare and Statistics Association. Ministry of Health, Labour and Welfare of Japan (Vital statistics). Tokyo: Health and Welfare and Statistics Association; 2007.
  4. Kotagal UR, Perlstein PH, Gamblian V, Donovan EF, Atherton HD. Description and evaluation of a program for the early discharge of infants from a neonatal intensive care unit. J Pediatr. 1995; 127(2):285-90.
  5. 5 - Merritt TA, Pillers D, Prows SL. Early NICU discharge of very low birth weight infants: A critical review and analysis. Semin Neonatol. 2003; 8(2):95–115.
  6. 6 - Altman M, Vanpee M, Bendito A, Norman M. Shorter hospital stay for moderately preterm infants. Acta Pediatr. 2006; 95(10):1228-33.
  7. Leaf A, Rose C, Ramsay L. Strategies for getting preterm infants home earlier. Arch Dis Child. 2008; 93(4):271-3.
  8. Brooten D, Kumar S, Brown LP, Butts P, Finkler SA, Bakewell-Sachs S, et  al. A randomised clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants. N Engl J Med. 1986; 315(15):934-9
  9. Martin RJ, Fanaroff AA, Walsh MC. Fanaroff & Martin's neonatal perinatal medicine: Disease of the fetus and infant. 9th ed. St. Louis: Mosby; 2010.

10. Cruz H, Guzman N, Rosales M, Bastidas J, Garcia J, Hurtado I, et al. Early hospital discharge of preterm very low birth weight infants. J Perinatol. 1997; 17(1):29-32.

11. Phibbs CS, Schmitt SK. Estimates of the cost and length of stay changes that can be attributed to one-week increases in gestational age for premature infants. Early Hum Dev. 2006; 82(2):85–95.

12. Underwood MA, Danielsen B, Gilbert WM. Cost, causes and rates of rehospitalization of preterm infants. J Perinatol. 2007; 27(10):614–9.

13. Kero PO, Makinen EO. Comparison between clinical and radiological classification of infants with respiratory distress syndrome (RDS). Eur J Pediatr. 1979; 130(4):271-8.

14. Jobe AH, Bancalari E. Bronchopulmonary dyplasia. Am J Respir Crit Care Med. 2001; 163(7):1723-9.

15. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986; 33(1):179-201.

16. Armanian AM, Kazemipour S, Mirbod SM, Hassanzade A. Comparison of prolonged low volume milk and routine volume milk on incidence of necrotizing enterocolitis in very low birth weight neonates. Pak J Med Sci. 2013; 29(Suppl 1):312-6.

17. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal  and  intraventricular  hemorrhage:  a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978, 92(4):529-34.

18. Ahmadpour‐Kacho M, PashaYZ, Aliabadi BM. Outcomes of very‐low‐birthweight infants after discharge with a discharge weight of 1500 grams. Pediatr Int. 2012; 54(2):196-9.

19. Tomashek, KM, Shapiro-Mendoza CK, Weiss J, Kotelchuck M, Barfield W, Evans S, et al. Early discharge among late preterm and term newborns and risk of neonatal morbidity. Semin Perinatol. 2006; 30(2):61-8.

20. Bathie J, Shaw J. Early discharge home from the neonatal unit with the support of naso-gastric tube feeding. J Neonatal Nurs. 2013; 19(4):213-6.

21. Smith VC, Zupancic JA, McCormick MC, Croen LA, Greene J, Escobar GJ, et al. Rehospitalization in the first year of life among infants with bronchopulmonary dysplasia. J Pediatr. 2004; 144(6):799-803.