Maternal and Child Health Journal

, Volume 17, Issue 6, pp 1016–1024

Health Care Utilization in the First Year of Life among Small- and Large- for-Gestational Age Term Infants

  • Patricia M. Dietz
  • Joanne H. Rizzo
  • Lucinda J. England
  • William M. Callaghan
  • Kimberly K. Vesco
  • F. Carol Bruce
  • Joanna E. Bulkley
  • Andrea J. Sharma
  • Mark C. Hornbrook
Article

Abstract

The objective of the study was to assess if small- and large-for gestational age term infants have greater health care utilization during the first year of life. The sample included 28,215 singleton term infants (37–42 weeks) without major birth defects delivered from 1998 through 2007 and continuously enrolled at Kaiser Permanente Northwest for 12 months after delivery. Birth weight for gestational age was categorized into 3 levels: <10th percentile (SGA), 10–90th percentile (AGA), >90th percentile (LGA). Length of delivery hospitalization, re-hospitalizations and sick/emergency room visits were obtained from electronic records. Logistic regression models estimated associations between birth weight category and re-hospitalization. Generalized linear models estimated adjusted mean number of sick/emergency visits. Among term infants, 6.2 % were SGA and 13.9 % were LGA. Of infants born by cesarean section, SGA infants had 2.7 higher odds [95 % 1.9, 3.8] than AGA infants of staying ≥5 nights during the delivery hospitalization; of those born vaginally, SGA infants had 1.5 higher adjusted odds [95 % 1.1, 2.1] of staying ≥4 nights. LGA compared to AGA infants had higher odds of re-hospitalization within 2 weeks of delivery [OR 1.25, 95 % CI 0.99, 1.58] and of a length of stay ≥4 days during that hospitalization [OR 2.6, 95 % CI 1.3, 5.0]. The adjusted mean number of sick/emergency room visits was slightly higher in SGA (7.8) than AGA (7.5) infants (P < .05). Term infants born SGA or LGA had greater health care utilization than their counterparts, although the increase in utilization beyond the initial delivery hospitalization was small.

Keywords

Low birth weight Fetal growth restriction Large for gestational age Macrosomia Health care utilization 

References

  1. 1.
    Minior, V. K., & Divon, M. Y. (1998). Fetal growth restriction at term: Myth or reality? Obstetrics and Gynecology, 92(1), 57–60.PubMedCrossRefGoogle Scholar
  2. 2.
    Zhang, X., Decker, A., Platt, R. W., & Kramer, M. S. (2008). How big is too big? The perinatal consequences of fetal macrosomia. American Journal of Obstetrics and Gynecology, 198(5), 517.e1–517.e6.CrossRefGoogle Scholar
  3. 3.
    Stotland, N. E., Caughey, A. B., Breed, E. M., & Escobar, G. J. (2004). Risk factors and obstetric complications associated with macromia. International Journal of Gynaecology and Obstetrics, 87(3), 220–226.PubMedCrossRefGoogle Scholar
  4. 4.
    McIntire, D. D., Bloom, S. L., Casey, B. M., & Leveno, K. J. (1999). Birthweight in relation to morbidity and mortality among newborn infants. New England Journal of Medicine, 340(16), 1234–1238.PubMedCrossRefGoogle Scholar
  5. 5.
    Seeds, J. W., & Peng, J. (1998). Impaired growth and risk of fetal death: Is the tenth percentile the appropriate standard? American Journal of Obstetrics and Gynecology, 178, 658–669.PubMedCrossRefGoogle Scholar
  6. 6.
    Hornbrook, M. C., Whitlock, E. P., Berg, C. J., et al. (2006). Development of an algorithm to identify pregnancy episodes in an integrated health care delivery system. Health Services Research, 42, 908–927.CrossRefGoogle Scholar
  7. 7.
    Callaghan, W. M., & Dietz, P. M. (2010). Differences in birth weight for gestational age distributions according to the measures used to assign gestational age. American Journal of Epidemiology, 171(7), 826–836.PubMedCrossRefGoogle Scholar
  8. 8.
    Maisels, M. S., & Kring, E. A. (1998). Length of stay, jaundice, and hospital readmission. Pediatrics, 101, 995–998.PubMedCrossRefGoogle Scholar
  9. 9.
    Qiu, X., Lodha, A., Shah, P. S., Sankaran, K., Seshia, M. M., Yee, W., et al. (2012). Canadian Neonatal Network. Neonatal outcomes for small for gestational age preterm infants in Canada. American Journal of Perinatology, 29(2), 87–94.PubMedCrossRefGoogle Scholar
  10. 10.
    Luu, T. M., Lefebvre, F., Riley, P., & Infante-Rivard, C. (2010). Continuing utilisation of specialised health services in extremely preterm infants. Archives of Disease in Childhood. Fetal and Neonatal Edition, 95(5), F320–F325.PubMedCrossRefGoogle Scholar
  11. 11.
    Bird, T. M., Bronstein, J. M., Hall, R. W., Lowery, C. L., Nugent, R., & Mays, G. P. (2010). Late preterm infants: birth outcomes and health care utilization in the first year. Pediatrics, 126(2), e311–e319.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA)  2012

Authors and Affiliations

  • Patricia M. Dietz
    • 1
  • Joanne H. Rizzo
    • 2
  • Lucinda J. England
    • 1
  • William M. Callaghan
    • 1
  • Kimberly K. Vesco
    • 2
  • F. Carol Bruce
    • 1
  • Joanna E. Bulkley
    • 2
  • Andrea J. Sharma
    • 1
  • Mark C. Hornbrook
    • 2
  1. 1.Division of Reproductive Health, National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.The Center for Health ResearchKaiser Permanente NorthwestPortlandUSA

Personalised recommendations