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Relationship between large and small for gestational age and hospital readmission after postpartum discharge: a population-based, data-linkage study

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Abstract

This study aims to determine the association of small for gestational age (SGA) and large for gestational age (LGA) at birth with hospital readmission after postpartum discharge for up to 28 days of delivery. This is a population-based, data-linkage study using the French National Uniform Hospital Discharge Database. “Healthy” singleton term infants born between January 1st, 2017, and November 30th, 2018, in the French South region were included. SGA and LGA were defined as birth weight < 10th and > 90th percentiles, respectively, according to sex and gestational age. A multivariable regression analysis was performed. Among 67,359 included infants, 2441 (3.6%) were readmitted, and 61% of them were hospitalized within 14 days postpartum. Hospitalized infants were more likely to be LGA at birth (10.3% vs. 8.6% in non-hospitalized infants, p < 0.01); the proportion of SGA infants did not differ between both groups. Compared to appropriate birth weight for GA (AGA) infants, LGA infants were more often hospitalized for infectious diseases (57.7% vs. 51.3%, p = 0.05). After regression analysis, LGA infants had a 20% higher odds of being hospitalized than those born AGA (aOR (95%CI) = 1.21 (1.06–1.39)), while aOR (95%CI) for SGA was 1.11 (0.96–1.28).

Conclusion: In contrast to SGA, LGA was associated with hospital readmission during the first month of life. Follow-up protocols that include LGA should be evaluated.

What is Known:

• Newborns are at high risk of hospital readmission during the postpartum period.

• However, the influence of appropriateness for gestational age at birth, i.e. being born small for gestational age (SGA) or large for gestational age (LGA), has been little evaluated.

What is New:

• In contrast to SGA born infants, we found that infants born LGA were at high risk of hospital admission and the main cause was infectious diseases.

• This population should be considered at risk of early adverse outcomes and should require attentive medical follow-up after postpartum discharge.

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Data availability

The French National Uniform Hospital Discharge Database data can only be accessed through a secure server after obtaining requisite ethical and data protection authorizations. The data are available upon request from the authors.

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Author information

Author notes

  1. Marion Nimal and Camille Ravel contributed equally to this work and share first authorship.

Authors and Affiliations

  1. APHM, Hospital University La Conception, Neonatal Unit, Marseille, France

    Marion Nimal, Camille Ravel, Clotilde Des Robert & Farid Boubred

  2. Regional Health Agency, Provence-Alpes-Côte d’Azur, Marseille, France

    Steve Nauleau, David Lapalus & Olivier Bernard

  3. APHM, Public Health and Medical Information Department, CEReSS - Health Service Research and Quality of Life Centre, 3279, Marseille, EA, France

    Sophie Tardieu

  4. Aix-Marseille University, INSERM, INRAE, C2VN, Marseille, France

    Farid Boubred

Authors
  1. Marion Nimal
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  2. Camille Ravel
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  3. Steve Nauleau
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  4. David Lapalus
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  5. Olivier Bernard
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  6. Clotilde Des Robert
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  7. Sophie Tardieu
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  8. Farid Boubred
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Contributions

Nimal Marion and Camille Ravel designed the data collection, analysed the data, drafted the initial manuscript, and reviewed and revised the manuscript. Steve Nauleau and David Lapidus designed the data collection instruments, collected data, and carried out the initial analyses. Clotilde Des Robert and Sophie Tardieu conceptualized and designed the study, and Farid Boubred conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Farid Boubred.

Ethics declarations

Ethics approval and consent to participate

This is an observational study using the data from the French National Uniform Hospital Discharge Database (Programme de Médicalisation du Système d’Information (PMSI)). All data are fully anonymized; informed written patient consent and ethical committee approval are not required in accordance of the French law after a deliberation of the French Commission for Data Protection and Liberties (CNIL) with the methodological reference MR005. All French regulations have been respected.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca.

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Nimal, M., Ravel, C., Nauleau, S. et al. Relationship between large and small for gestational age and hospital readmission after postpartum discharge: a population-based, data-linkage study. Eur J Pediatr 182, 2245–2252 (2023). https://doi.org/10.1007/s00431-023-04908-2

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  • DOI: https://doi.org/10.1007/s00431-023-04908-2

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