van Hasselt Tim J, Dorner Rebecca A, Katheria Anup, Battersby Cheryl, Gale Chris, Lo David K H, Seaton Sarah E
Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom.
Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California.
JAMA Netw Open. 2025 Sep 2;8(9):e2530123. doi: 10.1001/jamanetworkopen.2025.30123.
Children born very preterm have increased health care use. However, there is a lack of research using contemporary national data quantifying hospitalizations after neonatal discharge to inform counseling of families and health care provision.
To examine hospital admissions after neonatal discharge and before 2 years of age among children born at less than 32 weeks' gestation and assess associations between hospitalization and neonatal morbidities.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from all neonatal units and admitting hospitals in England and Wales supplied from the National Neonatal Research Database, linked with the Hospital Episode Statistics Admitted Patient Care database in England and the Patient Episode Database for Wales. Participants were children born at 22 through 31 weeks' gestation from January 1, 2013, to December 31, 2018, who were admitted to neonatal units and discharged home. Analysis was performed from June 26, 2024, to June 3, 2025.
Gestational age; sex; small-for-gestational-age status; season at time of neonatal discharge; neonatal morbidities, including bronchopulmonary dysplasia (BPD), severe necrotizing enterocolitis (NEC), and neonatal brain injury; and number of morbidities.
Prevalence of hospital admission and total calendar days hospitalized across all admissions. Negative binomial regression was used to calculate the adjusted incidence rate ratio (AIRR) for total calendar days hospitalized, adjusting for gestational age, sex, small for gestational age, and season of neonatal discharge.
Among the 39 413 children included (21 360 [54.2%] male; median gestational age at birth, 29 weeks [IQR, 27-31 weeks]), 26 276 (66.7%) did not have major neonatal morbidities. A total of 26 498 children (67.2%) had at least 1 episode of hospitalization between neonatal discharge and the age of 2 years. This ranged from 6138 of 10 444 children born at 31 weeks' gestation (58.8%) to 450 of 517 born at less than 24 weeks (87.0%). The median number of total calendar days hospitalized across admissions increased from 1 day (IQR, 0-5 days) for children born at 31 weeks' gestation to 8 days (IQR, 3-21 days) for those born at less than 24 weeks. Neonatal morbidities were associated with increased total days hospitalized; the AIRR for total hospitalization days for children with vs without BPD was 1.80 (95% CI, 1.72-1.88), for those with vs without severe NEC was 1.88 (95% CI, 1.65-2.15), and for those with vs without neonatal brain injury was 1.46 (95% CI, 1.36-1.57). Combinations of morbidities were associated with total expected days hospitalized: the model estimated that a child born at less than 24 weeks' gestation with 3 morbidities would have 40.6 days (95% CI, 34.8-44.3 days) of hospitalization before age 2 years.
In this cohort study of children born very preterm discharged from neonatal care in England and Wales, most children experienced hospitalization before their second birthday, and hospitalizations were associated with lower gestational age and neonatal morbidities. These findings can aid counseling and suggest that further research should investigate interventions to prevent hospitalization in this population.
极早产出生的儿童医疗保健使用量增加。然而，缺乏利用当代国家数据量化新生儿出院后住院情况以指导家庭咨询和医疗保健提供的研究。
研究孕周小于32周出生的儿童在新生儿出院后至2岁前的住院情况，并评估住院与新生儿疾病之间的关联。
设计、背景和参与者：这项回顾性队列研究使用了来自英国和威尔士所有新生儿病房及收治医院的数据，这些数据来自国家新生儿研究数据库，并与英格兰的医院事件统计收治患者护理数据库以及威尔士的患者事件数据库相链接。参与者为2013年1月1日至2018年12月31日期间孕周为22至31周、入住新生儿病房并出院回家的儿童。分析于2024年6月26日至2025年6月3日进行。
孕周；性别；小于胎龄儿状态；新生儿出院时的季节；新生儿疾病，包括支气管肺发育不良（BPD）、严重坏死性小肠结肠炎（NEC）和新生儿脑损伤；以及疾病数量。
所有入院病例的住院患病率和总住院天数。采用负二项回归计算总住院天数的调整发病率比（AIRR），并对孕周、性别、小于胎龄和新生儿出院季节进行调整。
在纳入的39413名儿童中（21360名[54.2%]为男性；出生时的中位孕周为29周[IQR，27 - 31周]），26276名（66.7%）没有严重的新生儿疾病。共有26498名儿童（67.2%）在新生儿出院至2岁之间至少有1次住院经历。这一比例从孕周为31周出生的10444名儿童中的6138名（58.8%）到孕周小于24周出生的517名儿童中的450名（87.0%）不等。所有入院病例的总住院天数中位数从孕周为31周出生的儿童的1天（IQR，0 - 5天）增加到孕周小于24周出生的儿童的8天（IQR，3 - 21天）。新生儿疾病与总住院天数增加相关；患有BPD与未患BPD的儿童相比，总住院天数的AIRR为1.80（95%CI，1.72 - 1.88），患有严重NEC与未患严重NEC的儿童相比为1.88（95%CI，1.65 - 2.15），患有新生儿脑损伤与未患新生儿脑损伤的儿童相比为1.46（95%CI，1.36 - 1.57）。疾病组合与总预期住院天数相关：模型估计，孕周小于24周且患有3种疾病的儿童在2岁前的住院天数为40.6天（95%CI，34.8 - 44.3天）。
在这项对英格兰和威尔士新生儿护理出院的极早产出生儿童的队列研究中，大多数儿童在2岁生日前经历过住院，且住院与较低的孕周和新生儿疾病相关联。这些发现有助于提供咨询，并表明进一步的研究应调查预防该人群住院的干预措施。
