Early Term Delivery and Health Care Utilization in the First Year of Life

• Published in: The Journal of pediatrics 2012-08, Vol.161 (2), p.234-239.e1
• Main Authors: Dietz, Patricia M., DrPH, Rizzo, Joanne H., MPA, England, Lucinda J., MD, Callaghan, William M., MD, Vesco, Kimberly K., MD, Bruce, F. Carol, MPH, Bulkley, Joanna E., PhD, Sharma, Andrea J., PhD, Hornbrook, Mark C., PhD
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Cesarean Section; congenital abnormalities; Delivery, Obstetric; diabetes; Emergency Service, Hospital - utilization; Female; fetal development; General aspects; Gestational Age; health services; Health Services - utilization; Humans; hypertension; Infant; Infant, Newborn; Infant, Newborn, Diseases - therapy; infants; Length of Stay; linear models; Medical sciences; Patient Readmission; Pediatrics; Pregnancy; regression analysis; Term Birth; Young Adult
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2012.02.005

Objective To assess health care utilization during the first year of life among early term-born infants. Study design We assessed health care utilization of 22 420 singleton term infants (37-42 weeks gestational age [GA]) without major birth defects, fetal growth restriction, or exposure to diabetes or hypertension in utero, delivered between 1998 and 2007 and continuously enrolled at Kaiser Permanente Northwest for 12 months after delivery. GA, duration of delivery hospitalization, and postdelivery rehospitalizations and sick/emergency room visits in the first year of life were obtained from electronic medical records. Logistic regression models were used to estimate associations between GA and number of hospitalizations and length of stay. Generalized linear models were used to estimate the adjusted mean number of sick/emergency visits. Results Overall, 20.9% of term infants were born early. Infants delivered vaginally at 37 weeks GA had a 2.2 greater odds (95% CI, 1.6-3.1) of staying 4 or more days compared with those born at 39-40 weeks GA. Similar association was found among infants delivered by cesarean delivery at 37 or 38 weeks GA. Infants born at 37 weeks GA had increased odds of being rehospitalized within 2 weeks of delivery (OR, 2.6; 95% CI, 1.9-3.6). The adjusted mean number of sick/emergency room visits was higher for infants born at 37 and 38 weeks GA than for those born at 39-40 weeks GA (8.1, 7.7, and 7.3, respectively; P < .0001). Conclusions Early term-born infants had greater health care utilization during their entire first year of life than infants born at 39-40 weeks GA.