Department of Pediatrics, University of California, San Francisco, California.
Independent Researcher, Overland Park, Kansas.
Hosp Pediatr. 2023 May 1;13(5):426-439. doi: 10.1542/hpeds.2022-006931.
A broad understanding of the scope of birth hospitalizations in the United States is lacking. We aimed to describe the demographics and location of birth hospitalizations in the United States and rank the most common and costly conditions documented during birth hospitalizations.
We conducted a cross-sectional analysis of the 2019 Kids' Inpatient Database, a nationally-representative administrative database of pediatric discharges. All hospitalizations with the indicator "in-hospital birth" and any categorized by the Pediatric Clinical Classification System as "liveborn" were included. Discharge-level survey weights were used to generate nationally-representative estimates. Primary and secondary conditions coded during birth hospitalizations were categorized using the Pediatric Clinical Classification System, rank-ordered by total prevalence and total marginal costs (calculated using design-adjusted lognormal regression).
In 2019, there were an estimated 5 299 557 pediatric hospitalizations in the US and 67% (n = 3 551 253) were for births, totaling $18.1 billion in cost. Most occurred in private, nonprofit hospitals (n = 2 646 685; 74.5%). Prevalent conditions associated with birth admissions included specified conditions originating in the perinatal period (eg, pregnancy complications, complex births) (n = 1 021 099; 28.8%), neonatal hyperbilirubinemia (n = 540 112; 15.2%), screening or risk for infectious disease (n = 417 421; 11.8%), and preterm newborn (n = 314 288; 8.9%). Conditions with the highest total marginal costs included specified conditions originating in perinatal period ($168.7 million) and neonatal jaundice with preterm delivery ($136.1 million).
Our study details common and costly areas of focus for future quality improvement and research efforts to improve care during term and preterm infant birth hospitalizations. These include hyperbilirubinemia, infectious disease screening, and perinatal complications.
目前人们对美国分娩住院的范围缺乏广泛的了解。本研究旨在描述美国分娩住院的人口统计学特征和地理位置，并对分娩住院期间记录的最常见和最昂贵的疾病进行排名。
我们对 2019 年儿童住院数据库（一个全国代表性的儿科出院行政数据库）进行了横断面分析。所有带有“院内分娩”指标且儿科临床分类系统归类为“活产”的住院治疗均被纳入。使用出院级别的调查权重生成具有全国代表性的估计值。使用儿科临床分类系统对分娩住院期间记录的主要和次要疾病进行分类，根据总患病率和总边际成本（使用设计调整后的对数正态回归计算）进行排序。
2019 年，美国估计有 5299557 例儿科住院治疗，其中 67%（n=3551253）为分娩住院治疗，总费用为 181 亿美元。大多数分娩住院治疗发生在私立非营利性医院（n=2646685；74.5%）。与分娩住院相关的常见疾病包括特定的围产期来源疾病（如妊娠并发症、复杂分娩）（n=1021099；28.8%）、新生儿高胆红素血症（n=540112；15.2%）、传染病筛查或风险（n=417421；11.8%）和早产儿（n=314288；8.9%）。总边际成本最高的疾病包括围产期来源特定疾病（1.687 亿美元）和早产新生儿黄疸伴分娩（1.361 亿美元）。
本研究详细描述了未来质量改进和研究工作的重点领域，以改善足月和早产婴儿分娩住院的护理。这些领域包括高胆红素血症、传染病筛查和围产期并发症。
