Kumar Vivek, Anand Pratima, Verma Ankit, Thukral Anu, Sankar M Jeeva, Agarwal Ramesh
Newborn Health Knowledge Centre (NHKC), Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Department of Pediatrics, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.
Indian J Pediatr. 2025 May;92(5):502-508. doi: 10.1007/s12098-023-04999-7. Epub 2024 Jan 22.
To determine the incidence of repeat-hospitalization amongst neonates with gestation <32 wk or birth weight <1500 g within 6 mo of birth.
All live births with gestation <32 wk or birth weight <1500 g born at a level-III NICU were prospectively enrolled and followed up through routine visits, multimedia and telephonically, fortnightly for re-hospitalization details till 6 mo of postnatal age. Main outcome measures were incidence, causes and risk factors for repeat-hospitalization.
Of the 131 neonates enrolled, incidence and incidence density of repeat-hospitalization were 16% (95% CI 10.2-23.4) and 3.6 per 100 person-months, respectively. The most common causes for repeat-hospitalizations were pneumonia (n = 8; 29.6%), sepsis (n = 5, 18.5%), gastroenteritis (n = 3, 11.1%) and severe anemia (n = 2, 7.4%). Majority of repeat-hospitalizations (92.6%; 95% CI 74.1-98.5) occurred within 2 mo of discharge. The median hospital stay during repeat-hospitalizations was 4 d (IQR 1-21). On multivariate analysis, lower socioeconomic status was significantly associated with repeat-hospitalization (aOR 5.9, 1.3-23). Death after discharge occurred in 3 (2.3%) infants and were due to sudden infant death syndrome, complex cyanotic heart disease and pneumonia with multiple co-morbidities (one each). All deaths occurred at home.
Nearly one-sixth of very low birth weight (VLBW) or very preterm infants required repeat-hospitalization after discharge, primarily within 2 mo of discharge. Infections, especially pneumonia, being the most common reason. A comprehensive follow-up package of post-discharge care for prevention of morbidities and timely hospital care for ongoing morbidities is required for optimal long-term survival of these infants.
确定出生孕周<32周或出生体重<1500克的新生儿在出生后6个月内再次住院的发生率。
前瞻性纳入所有在三级新生儿重症监护病房出生的孕周<32周或出生体重<1500克的活产婴儿，并通过常规访视、多媒体及电话随访，每两周了解一次再次住院详情，直至出生后6个月。主要观察指标为再次住院的发生率、原因及危险因素。
在纳入的131例新生儿中，再次住院的发生率及发生率密度分别为16%（95%可信区间10.2 - 23.4）和每100人月3.6次。再次住院最常见的原因是肺炎（n = 8；29.6%）、败血症（n = 5，18.5%）、胃肠炎（n = 3，11.1%）和重度贫血（n = 2，7.4%）。大多数再次住院（92.6%；95%可信区间74.1 - 98.5）发生在出院后2个月内。再次住院期间的中位住院时间为4天（四分位间距1 - 21天）。多因素分析显示，社会经济地位较低与再次住院显著相关（调整后比值比5.9，1.3 - 23）。出院后有3例（2.3%）婴儿死亡，原因分别为婴儿猝死综合征、复杂性青紫型心脏病和伴有多种合并症的肺炎（各1例）。所有死亡均发生在家中。
近六分之一的极低出生体重（VLBW）或极早产儿出院后需要再次住院，主要在出院后2个月内。感染，尤其是肺炎，是最常见的原因。为了这些婴儿的最佳长期生存，需要一套全面的出院后护理随访方案以预防发病，并对持续发病进行及时的住院治疗。
