Abstract
Background
Prematurity is the biggest contributor to admissions in the neonatal intensive care unit (NICU). The period following hospital discharge is a vital continuum for the very low birth weight (VLBW) infant. The objective of this study was to assess the impact of a unique discharge and follow-up process on the outcomes of VLBW infants leaving the NICU.
Methods
All outpatient health care usage by VLBW infants born in the study year (cases) was retrospectively tracked through 12 months of age. A cohort of healthy newborn infants were matched by birthdate to each VLBW infant (controls) and similarly tracked.
Results
In this study, there were 85 cases and 85 controls. The mean gestational age at birth for the cases was 29.1±2.7 weeks with a mean birth weight of 1079±263 g. That of the controls was 38.9±1.3 weeks and 3202±447 g. Over 90% of both populations had Medicaid coverage. All VLBW infants received care at the Special Care Developmental Follow-Up Clinic. When compared with the controls, VLBW infants discharged from the NICU made fewer acute, unscheduled visits to the Emergency Department or Urgent Care Clinic (2.3±2.5 vs. 3.7±3.5; P=0.007) despite their high-risk medical and social status. Their growth pattern showed significant “catch-up” and was similar to the matched controls at the last scheduled visit for each group.
Conclusions
Outcomes including health care utilization in high-risk infants can be improved through meticulous discharge planning and follow-up measures that utilize existing hospital infrastructure to provide affordable comprehensive care.
Similar content being viewed by others
References
Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Osterman MJ, et al. Births: final data for 2008. Natl Vital Stat Rep 2010;59: 1, 3–71.
Cuevas KD, Silver DR, Brooten D, Youngblut JM, Bobo CM. The cost of prematurity: hospital charges at birth and frequency of rehospitalizations and acute care visits over the first year of life: a comparison by gestational age and birth weight. Am J Nurs 2005;105:56–64; quiz 65.
Snyder U. May/June 2004: Preterm birth as a social disease. Medscape Ob/Gyn Women Health 2004:9(2). www.medscape/viewarticle/481732 (accessed May 13, 2012).
Hack M, Flannery DJ, Schluchter M, Cartar L, Borawski E, Klein N. Outcomes in young adulthood for very-low-birthweight infants. N Engl J Med 2002;346:149–157.
Mills MM, Sims DC, Jacob J. Implementation and case-study results of potentially better practices to improve the discharge process in the neonatal intensive care unit. Pediatrics 2006;118:124–133.
Rogowski J. Cost-effectiveness of care for very low birth weight infants. Pediatrics 1998;102:35–43.
Wang CJ, McGlynn EA, Brook RH, Leonard CH, Piecuch RE, Hsueh SI, et al. Quality-of-care indicators for the neurodevelopmental follow-up of very low birth weight children: Results of an expert panel process. Pediatrics 2006;117:2080–2092.
Gray D, Woodward LJ, Spencer C, Inder TE, Austin NC. Health service utilisation of a regional cohort of very preterm infants over the first 2 years of life. J Pediatr Child Health 2006;42:377–383.
McLaurin KK, Hall CB, Jackson EA, Owens OV, Mahadevia PJ. Persistence of morbidity and cost differences between latepreterm and term infants during the first year of life. Pediatrics 2009;123:653–659.
Follow-up Care of High-Risk Infants. Pediatrics 2004;114:1377–1397.
American Academic of Pediatrics: Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics 2008;122:1119–1126.
American Academic of Pediatrics. Committee on Practice and Ambulatory Medicine: Recommendations for preventive pediatric health care. Pediatrics 2000;105: 645.
Cohen E, Kuo DZ, Agrawal R, Berry JG, Bhagat SKM, Simon TD, et al. Children with Medical complexity: An emerging population for clinical and research initiatives. Pediatrics 2011;127:529–538.
Healthy People 2010. A systemic approach to health improvement. http://www.healthypeople.gov/2010 (accessed March 23, 2013).
American Academy of Pediatrics. Medical Home Initiatives for Children with Special Needs Project Advisory Committee. The Medical Home. Pediatrics 2002;110:184–186.
Raphael JL, Zang Y, Liu H, Tapia C, Giardino AP. Association of Medical Home Care and Disparities in Emergency Care Utilization among Children with Special Health care Needs. Acad Pediatr 2009;9:242–248.
Liberatos P, Link BG, Kelsey JK. The measurement of social class in epidemiology. Epidemiol Rev 1988;10:87–121.
Cartland JD, McManus MA, Flint SS. A decade of Medicaid in perspective: what have been the effects on children? Pediatrics 1993;91:287–295.
Brooks-Gunn J, McCormick MC, Klebanov PK, McCarton C. Health care use of 3-year-old low birth weight premature children; effects of family and neighborhood poverty. J Pediatr 1998;132:971–975.
Olson ME, Diekema D, Elliot BA, Renier CM. Impact of income and income inequality on infant health outcomes in the United States. Pediatrics 2010;126:1165–1173.
Campbell FA, Ramey CT. Effects of early intervention on intellectual and academic achievement: a follow-up study of children from low-income families. Child Dev 1994;65:684–698.
Guralnick MJ. Effectiveness of early intervention for vulnerable children: a developmental perspective. Am J Ment Retard 1998;102:319–345.
Orton J, Spittle A, Doyle L, Anderson P, Boyd R. Do early intervention programmes improve cognitive and motor outcomes for preterm infants after discharge? A systematic review. Dev Med Child Neurol 2009;51:851–859.
Brandon GD, Adeniyi-Jones S, Kirby S, Webb D, Culhane J, Greenspan JS. Are outcomes and care processes for preterm neonates influenced by health insurance status? Pediatrics 2009;124:122–127.
Schuster MA, Wood DL, Duan N, Mazel RM, Sherbourne CD, Halfon N. Utilization of well-child care services for African-American infants in a low-income community: results of a randomized, controlled case management/home visitation intervention. Pediatrics 1998;101:999–1005.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Waruingi, W., Iyer, S. & Collin, M. Improving health care usage in a very low birth weight population. World J Pediatr 11, 239–244 (2015). https://doi.org/10.1007/s12519-014-0492-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12519-014-0492-y