Early discharge and readmission to hospital in the first month of life in the Northern Region of the UK during 1998: A case cohort study

Newcastle University, Newcastle-on-Tyne, England, United Kingdom
Archives of Disease in Childhood (Impact Factor: 2.9). 03/2005; 90(2):119-24. DOI: 10.1136/adc.2003.040766
Source: PubMed


To study the frequency and associations of early postpartum discharge and infant readmission to hospital.
Infants readmitted to hospital during the first 28 days of life in 1998 in the Northern Region of the UK were studied.
A total of 4743 of 11,338 (42%) babies were discharged on or before the first postnatal day. Rates of early discharge varied significantly between hospitals. Infants <2500 g at birth (adjusted odds ratio (AOR) 0.44, 95% CI 0.29 to 0.66), infants 35-37 weeks gestation at birth (AOR 0.65, 95% CI 0.49 to 0.86), and firstborn infants (AOR 0.09, 95% CI 0.08 to 0.10) were less likely to be discharged early. Women from more deprived areas were more likely to be discharged early (AOR 1.37, 95% CI 1.12 to 1.67). A total of 907 of 32,015 (2.8%) babies liveborn in the region were readmitted to hospital during 1998. Readmission rates varied significantly by hospital of birth but not by timing of discharge. Babies <2500 g at birth (AOR 1.95, 95% CI 1.16 to 3.28) and babies born at 35-37 weeks gestation (AOR 1.72, 95% CI 1.15 to 2.57) were more likely to be readmitted. Breast fed babies were less likely to be readmitted (AOR 0.69, 95% CI 0.53 to 0.90). Infants initially discharged early were not more likely to be readmitted.
Early discharge occurred variably in the Northern Region in 1998. It is not associated with readmission to hospital. Breast feeding is associated with lower rates of readmission to hospital.

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    • "This seems hopeful, but is it only due to a natural adaptation during the years or also the result of increased awareness leading to improved follow-up and medical guidance? These are questions that remain to be answered, although various reports do suggest a protective effect of specific follow-up programs [3] [25]. "
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    ABSTRACT: There is a gap in the knowledge of longterm outcome of mild to moderate prematures compared to the extreme prematures or very low birth weight infants. Determine health-related quality of life (HRQoL) and prevalence of emotional and behavioral problems in (pre-)school age children born at 32 to 36 weeks' gestation. A descriptive cohort study in a non-Neonatal Intensive Care Unit. Patient characteristics, diagnoses, treatment and social economic status (SES) were analyzed. Study tools were the TNO-AZL Preschool Quality of Life (TAPQoL) and Child Behavior Checklist (CBCL). 362 children born between 32 and 36 weeks' gestation who had a follow-up evaluation at 2-5 years of age. Health-related quality of life and the occurrence of emotional and behavioral problems. Main characteristics (mean±SD) were: gestation 34.7±1 weeks and birth weight 2360±444 g. Most families were two-parent middle-class households with parents employed at their educational level. Questionnaire response rate was 62.7%. The 12-item TAPQoL showed significantly lower scores for stomach and liveliness, while scores for behavior, communication and sleep were significantly higher compared to the general population. The TAPQoL subscale score for lung problems was significantly lower for children who had received continuous positive airway pressure (CPAP). CBCL scores were within the validated normal range although the study-population scored higher on emotionally reactive, somatic complaints and attention problems compared to their full-term peers. Children born at 32 to 36 weeks' gestational age do not experience an overall lower HR-QoL at 2 to 5 years of age. CPAP results in lower HRQoL scores for lung problems. The overall occurrence of behavioral and emotional problems does not differ from the general term-born pediatric population. Several subitems need further attention.
    Early human development 06/2011; 87(10):705-9. DOI:10.1016/j.earlhumdev.2011.05.011 · 1.79 Impact Factor
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    • "In the UK, investigations on the connection between early discharge and re-hospitalization within the first month reveal that 2.8% of new-borns are re-hospitalized due to infections, ‘colic' feeding problems, and jaundice. The authors conclude re-hospitalization is not dependent on the time of leaving hospital and that breast-fed children are at lower risk of re-hospitalization (12). In Sweden, the risk of re-hospitalization was similar when comparing those cared for in the maternity ward and those who were discharged early, 1.7% (13). "
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    ABSTRACT: To gain a deeper understanding of first-time parents' experiences of early discharge from hospital after delivery and home-based postnatal care. The study was comprised of focus group interviews, interviews with couples and with fathers. Twenty-one parents participated. Inclusion criteria: healthy women who have given birth to their first child after a normal pregnancy and delivery, the women's partners, healthy and full term babies, Swedish-speaking, discharge from the delivery ward within 24 hours, resident in the Uppsala community, the parents cohabited at the time of the delivery. The material was analysed by qualitative content analysis. Three themes emerged: The family's strategy, which describes the family's expectations of postnatal care and their experiences of the real situation. Some are flexible concerning going home early, and others have decided in advance. Self-reliance and strength, which explores the parents' feelings of security and uncertainty, freedom and independence, and shared responsibility. Breast-feeding is described as the 'main thing', an interactive learning process. Professional support in the home summarizes the parents' experience of the midwife's support at home. While conflicting feelings may be revealed during the first days, the midwife confirms their new roles as parents. The midwife is seen as a support and adviser to the parents. This study shows that parents welcome home-based postnatal care with professional support from midwives. We conclude that this care suits healthy families. We think it will be more important in the future to discriminate between healthy families and those in need of hospital care, than to focus on the moment when they leave the hospital, early or late.
    Upsala journal of medical sciences 05/2010; 115(2):131-7. DOI:10.3109/03009730903431809 · 1.98 Impact Factor
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    • "However, higher hospitalization rates indicate that late preterm children are at increased risk of developing more severe illnesses than term children [12]. A small number of studies have investigated short-term rehospitalization rates (2-4 weeks of discharge from the birth hospitalization) among late preterm children [12-14]. These studies all reported higher rehospitalization rates among late preterm children than in term infants. "
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    ABSTRACT: Background Rates of preterm birth are increasing worldwide and this increase is mostly due to infants born between 34 and 36 weeks of gestational age, the so-called "late preterm" births. The aim of this study was to assess the effect of late preterm birth over growth outcomes, assessed when children were 12 and 24 months old. Methods In 2004, all births taking place in Pelotas (Southern Brazil) were recruited for a cohort study. Late preterm (34/0-36/6 weeks of gestational age) and term children (37/0-42/6 weeks) were compared in terms of weight-for-age, length-for-age and weight-for-length z-scores. Weight-for-age, length-for-age and weight-for-length z-scores below -2 were considered, respectively, underweight, stunting and wasting. Singleton newborns with adequate weight for gestational age at birth, successfully followed-up either at 12 or 24 months of age were analyzed and adjusted odds ratios with 95% confidence intervals calculated through logistic regression. Results 3285 births were included, 371 of whom were late preterm births (11.3%). At 12 months, prevalence of underweight, stunting and wasting were, respectively, 3.4, 8.7 and 1.1% among late preterm children, against 1.0, 3.4 and 0.3% among term children. At 24 months, correspondent values were 3.0, 7.2 and 0.8% against 0.8, 2.9 and 0.4%. Comparing with the term children, adjusted odds of being underweighted among late preterm children was 2.57 times higher (1.27; 5.23) at 12 months and 3.36 times higher (1.56; 7.23) at 24; of being stunted, 2.35 (1.49; 3.70) and 2.30 (1.40; 3.77); and of being wasted, 3.98 (1.07; 14.85) and 1.87 (0.50; 7.01). Weight gain from birth to 12 and 24 months was similar in late preterm and term children, whereas length gain was higher in the former group in both periods. Conclusion Late preterm children grow faster than children born at term, but they are at increased risk of underweight and stunting in the first two years of life. Failure to thrive in the first two years may put them at increased risk of future occurrences of serious morbidity in late childhood and of chronic disease development in adult life.
    BMC Pediatrics 11/2009; 9(1). DOI:10.1186/1471-2431-9-71 · 1.93 Impact Factor
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