Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA.
J Pediatr. 2024 Jul;270:114014. doi: 10.1016/j.jpeds.2024.114014. Epub 2024 Mar 15.
To determine associations between sociodemographic and medical factors and odds of readmission after discharge from the neonatal intensive care unit for infants with very low birth weight (<1500g).
Cohort study using linked data from the California Perinatal Quality Care Collaborative, California Vital Statistics, and the Child Opportunity Index (COI) 2.0. Infants with very low birth weight born from 2009 through 2018 in California were considered. Odds ratios of readmission within 30 days of discharge adjusting for infant medical factors, maternal sociodemographic factors, and birth hospital were calculated via multivariable logistic regression and fixed-effect logistic regression models.
A total of 42 411 infants met inclusion criteria. Also, 8.5% of all infants were readmitted within 30 days of discharge. In addition to traditional medical risk factors, two sociodemographic factors were significantly associated with increased odds of readmission in adjusted models: payor other than private insurance for delivery [aOR = 1.25 (95% CI 1.14-1.36)] and maternal education of less than high school degree [aOR = 1.19 (95% CI 1.06-1.33)]. Neighborhood Child Opportunity Index was not associated with odds of readmission.
Sociodemographic factors, including lack of private insurance and lower maternal educational attainment, are significantly and independently associated with increased odds of readmission after neonatal intensive care unit discharge, in addition to traditional medical risk factors. Socioeconomic deprivation and health literacy may contribute to risk of readmission. Targeted discharge interventions focused on addressing social drivers of health warrant exploration.
确定社会人口学和医学因素与极低出生体重（<1500g）婴儿从新生儿重症监护病房出院后再入院的几率之间的关联。
使用加利福尼亚围产期质量护理合作组织、加利福尼亚生命统计和儿童机会指数（COI）2.0 的链接数据进行队列研究。考虑了 2009 年至 2018 年期间在加利福尼亚出生的极低出生体重婴儿。通过多变量逻辑回归和固定效应逻辑回归模型，根据婴儿的医疗因素、产妇社会人口学因素和分娩医院，计算了出院后 30 天内再入院的调整后比值比。
共有 42411 名婴儿符合纳入标准。此外，8.5%的婴儿在出院后 30 天内再次入院。除了传统的医疗危险因素外，两个社会人口学因素在调整后的模型中与再入院的几率增加显著相关：分娩时非私人保险的付款人[调整比值比（aOR）=1.25（95%置信区间 1.14-1.36）]和母亲教育程度低于高中学历[aOR=1.19（95%置信区间 1.06-1.33）]。邻里儿童机会指数与再入院几率无关。
社会人口学因素，包括缺乏私人保险和母亲教育程度较低，除了传统的医疗危险因素外，还与新生儿重症监护病房出院后再入院的几率显著且独立相关。社会经济剥夺和健康素养可能会增加再入院的风险。有针对性的出院干预措施侧重于解决健康的社会驱动因素值得探讨。
