California Preterm Birth Initiative.
Departments of Epidemiology & Biostatistics.
Hosp Pediatr. 2022 Jul 1;12(7):639-649. doi: 10.1542/hpeds.2021-006215.
Late preterm infants have an increased risk of morbidity relative to term infants. We sought to determine the rate, temporal trend, risk factors, and reasons for 30-day readmission.
This is a retrospective cohort study of infants born at 34 to 42 weeks' gestation in California between January 1, 2011, and December 31, 2017. Birth certificates maintained by California Vital Statistics were linked to discharge records maintained by the California Office of Statewide Health Planning and Development. Multivariable logistic regression was used to identify risk factors and derive a predictive model.
Late preterm infants represented 4.3% (n = 122 014) of the study cohort (n = 2 824 963), of which 5.9% (n = 7243) were readmitted within 30 days. Compared to term infants, late preterm infants had greater odds of readmission (odds ratio [OR]: 2.34 [95% confidence interval (CI): 2.28-2.40]). The temporal trend indicated increases in all-cause and jaundice-specific readmission infants (P < .001). The common diagnoses at readmission were jaundice (58.9%), infections (10.8%), and respiratory complications (3.5%). In the adjusted model, factors that were associated with greater odds of readmission included assisted vaginal birth, maternal age ≥34 years, diabetes, chorioamnionitis, and primiparity. The model had predictive ability of 60% (c-statistic 0.603 [95% CI: 0.596-0.610]) in late preterm infants who had <5 days length of stay at birth.
The findings contribute important information on what factors increase or decrease the risk of readmission. Longitudinal studies are needed to examine promising hospital predischarge and follow-up care practices.
相对于足月婴儿，晚期早产儿患病风险增加。本研究旨在确定 30 天内再入院率、时间趋势、危险因素和再入院原因。
本研究为回顾性队列研究，对象为 2011 年 1 月 1 日至 2017 年 12 月 31 日期间在加利福尼亚州出生、胎龄为 34 至 42 周的婴儿。加利福尼亚州生命统计数据维护的出生证明与加利福尼亚州全州卫生规划和发展办公室维护的出院记录相关联。采用多变量逻辑回归识别危险因素并建立预测模型。
晚期早产儿占研究队列（n=2824963）的 4.3%（n=122014），其中 5.9%（n=7243）在 30 天内再次入院。与足月婴儿相比，晚期早产儿再入院的可能性更大（优势比[OR]：2.34[95%置信区间（CI）：2.28-2.40]）。时间趋势表明，所有原因和黄疸特定原因的再入院婴儿数量均有所增加（P<0.001）。再入院的常见诊断为黄疸（58.9%）、感染（10.8%）和呼吸系统并发症（3.5%）。在调整后的模型中，与再入院可能性更大相关的因素包括辅助阴道分娩、产妇年龄≥34 岁、糖尿病、绒毛膜羊膜炎和初产妇。该模型在出生时住院时间<5 天的晚期早产儿中有 60%的预测能力（C 统计量为 0.603[95%CI：0.596-0.610]）。
研究结果提供了有关哪些因素增加或降低再入院风险的重要信息。需要进行纵向研究，以检验有前途的医院出院前和随访护理实践。
