Risk Factors for Emergency Department Visits or Hospital Readmissions in Late Preterm Infants

Friday, October 1, 2010
102 (Moscone Center)
Ramzan Shahid, MD, Amy L. Hanson, MD and Emily Brooks, M4, Pediatrics, Loyola University Medical Center, Maywood, IL

Purpose:   Late preterm infants (34 0/7 to 36 6/7 weeks gestational age) are known to have higher hospital readmission rates in the first month of life compared to term infants.  They also make up a substantial proportion of Emergency Department (ED) visits for all infants less than 1 month of age.  Little is known about the risk factors associated with ED visits or hospital readmission for late preterm infants.  The purpose of this study is to identify risk factors during the birth hospitalization in late preterm infants that may be associated with an ED visit or hospital readmission within 30 days of initial hospital discharge.

Methods:   We conducted a retrospective chart review of all late preterm infants born at the Loyola University Medical Center between January 2005 and December 2008.  The infants' uses of health care services were followed for 30 days from the time of hospital discharge from the Newborn Nursery or Neonatal Intensive Care Unit (NICU).

Results:   502 late preterm infants were followed for a full 30 days from the time of initial hospital discharge.  The factor associated with a statistically significant increased risk of an ED visit in the first 30 days after initial hospital discharge was gestational age of 36 weeks (OR=1.91).  Statistically significant factors associated with hospital readmission in the first 30 days included discharge at or before 48 hours of life (OR=2.34) and a birth hospitalization limited to the normal newborn nursery (OR=3.12).

Conclusions:   Our findings suggest that late preterm infants born at 36 weeks gestational age need to be monitored more closely after initial hospital discharge because they are more likely to have an ED visit within the first 30 days after discharge.  Furthermore, late preterm infants discharged less than 48 hours after birth or those late preterm infants who stayed in the normal newborn nursery are at increased risk for hospital readmission within 30 days of discharge.  We recommend that late preterm infants should not be discharged before 48 hours from birth.  We also recommend re-evaluating nursery policies that determine which unit the late preterm infants should be admitted to at birth.  A newborn nursery stay at birth appears to be a risk factor for hospital readmission, and therefore, careful consideration should be made about admitting late preterm infants to the NICU at birth.


Infant Variables


Odds Ratios for Hospital Readmission

36 weeks GA

1.52 (CI=0.74 -- 3.12)

Male gender

0.96 (CI=0.47 -- 1.94)

Weight >= 2500 grams

1.41 (CI=0.68 -- 2.89)

Discharged at <= 48 hrs

2.34 (CI=1.15 -- 4.79)

Nursery stay only

3.12 (CI=1.08 -- 9.03)