Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Rehospitalization of Extremely Low Birth Weight (ELBW) Infants: Are There Racial/Ethnic Disparities?

Journal of Perinatology volume 25, pages 656–663 (2005)Cite this article

Abstract

BACKGROUND:

Premature infants are at increased risk for rehospitalization after discharge from the hospital. Racial disparities are known to exist in pediatric health care.

OBJECTIVE:

To evaluate whether racial disparities exist in the proportion of extremely low birth weight (ELBW) infants rehospitalized prior to 18 months corrected age and the causes of rehospitalization.

METHODS:

The National Institute of Child Health and Human Development Neonatal Research Network database was used to identify all ELBW infants (n=2446) who were born between November 1, 1998 and May 31, 2000 at the 14 participating centers and discharged alive (n=1591). Infants were seen at 18–22 months corrected age for followup. Data related to maternal variables, race, socioeconomic status, medical morbidities, insurance, and rehospitalizations were recorded from the medical record and parent interview. Logistic regression analyses were used to examine the relationship of race/ethnicity and rehospitalization while controlling for gestational age, gender, center, maternal education, family income, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, ventriculoperitoneal (VP) shunt, respiratory syncytial virus (RSV) prophylaxis, and insurance type.

RESULTS:

In all, 1405 (88%) infants were evaluated at followup. The racial distribution of infants admitted, discharged, seen at followup, and rehospitalized were similar. Rehospitalization occurred at least once in 49% of the infants. In the logistic regression analyses, race was not a significant predictor for rehospitalization. The odds of rehospitalization were related to low family income, type of insurance, BPD, VP shunt, RSV prophylaxis, and center.

CONCLUSION:

Race was not a predominant variable in the risk of rehospitalization in this cohort of ELBW infants. Medical morbidities and low family income appear to be the major risk factors for rehospitalization.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Hack M, DeMonterice D, Merkatz IR, Jones P, Fanaroff AA . Rehospitalization of the very-low-birth-weight infant. Am J Dis Child 1981;135:263–266.

    Article  CAS  Google Scholar 

  2. Furman L, Baley J, Borawski-Clark E, Aucott S, Hack M . Hospitalization as a measure of morbidity among very low birth weight infants with chronic lung disease. J Pediatr 1996;128:447–452.

    Article  CAS  Google Scholar 

  3. Shattuck KE, Abu-Ghosh AM, Wildin SR, Landry SH, Smith KE . Respiratory morbidity in three year old children born preterm. Neonatal Intens Care 1998;11:11–15.

    Google Scholar 

  4. Stevens GD, Shi L . Racial and ethnic disparities in the primary care experience of children: a review of the literature. Med Care Res Rev 2003;60:3–30.

    Article  Google Scholar 

  5. Singh GK, Yu SM . Infant mortality in the United States: trends, differentials, and projections, 1950–2010. Am J Public Health 1995;85:957–964.

    Article  CAS  Google Scholar 

  6. Demissie K, Rhoads GG, Ananth CV, et al. Trends in preterm birth and neonatal mortality among blacks and whites in the United States from 1989 to 1997. Am J Epidemiol 2001;154:307–315.

    Article  CAS  Google Scholar 

  7. Papacek EM, Collins JW, Schulte NF, Goergen C, Drolet A . Differing postneonatal mortality rates of African American and white infants in Chicago: an ecologic study. Matern Child Health J 2002;6:99–105.

    Article  Google Scholar 

  8. Hahn BA . Racial and ethnic differences in the use of prescription medications. Pediatrics 1995;95:727–732.

    CAS  PubMed  Google Scholar 

  9. Park CH, Kogan MD, Overpeck MD, Casselbrant ML . Black–White differences in health care utilization among US children with frequent ear infections. Pediatrics 2002;109 (5):e84. URL: http://www.pediatrics.org/cgi/content/full/109/5/e8.

    Article  Google Scholar 

  10. McCormick MC, Shapiro S, Starfield BH . Rehospitalization in the first year of life for high risk survivors. Pediatrics 1980;66:991–999.

    CAS  Google Scholar 

  11. Cunningham CK, McMillan JA, Gross SJ . Rehospitalization for respiratory illness in infants of less than 32 weeks gestation. Pediatrics 1991;88:527–532.

    CAS  Google Scholar 

  12. Gregoire MC, Lefebvre F, Glorieux J . Health and developmental outcomes at 18 months in very preterm infants with bronchopulmonary dysplasia. Pediatrics 1998;101:856–860.

    Article  CAS  Google Scholar 

  13. Elder DE, Hagan R, Evans SF, Benninger HR, French NP . Hospital admissions in the first year of life in very preterm infants. J Pediatr Child Health 1999;35:145–150.

    Article  CAS  Google Scholar 

  14. Vohr BR, Wright LL, Dusick AM, et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993–1994. Pediatrics 2000;105:1216–1226.

    Article  CAS  Google Scholar 

  15. American Academy of Pediatrics. Committee on Infectious Diseases. Prevention of respiratory syncytial virus infections: indications for the use of palivizumab and update on the use of RSV-IGIV. Pediatrics 1998;102:1211–1216.

  16. Mays VM, Ponce NA, Washington DL, Cochran SD . Classification of race and ethnicity: implications for public health. Annu Rev Public Health 2003;24:83–110.

    Article  Google Scholar 

  17. Kaufman JS, Cooper RS . Considerations for use of racial/ethnic classification in etiologic research. Am J Epidemiol 2001;154:291–298.

    Article  CAS  Google Scholar 

  18. Jones CP . Race, racism, and the practice of epidemiology. Am J Epidemiol 2001;154:299–304.

    Article  CAS  Google Scholar 

  19. United States Census Bureau. http://aspe.hhs.gov/poverty/01poverty.htm.

  20. SAS/STAT User's Guide. Version 8. Cary, NC: SAS Institute Inc.; 1999.

  21. Schoendorf KC, Hogue CJ, Kleinman JC, Rowley D . Mortality among infants of black as compared with white college-educated parents. N Engl J Med 1992;326 (23):1522–1526.

    Article  CAS  Google Scholar 

  22. Akinbami LJ, Schoendorf KC . Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics 2002;110:315–322.

    Article  Google Scholar 

  23. Malloy MH, Graubard B . Access to home apnea monitoring and its impact on rehospitalization among very-low-birth-weight infants. Arch Pediatr Adolesc Med 1995;149:326–332.

    Article  CAS  Google Scholar 

  24. Yeo CL, Gray PH . Inguinal hernia in extremely preterm infants. J Pediatr Child Health 1994;30 (5):412–413.

    Article  CAS  Google Scholar 

  25. Harper RG, Garcia A, Sia C . Inguinal hernia: a common problem of premature infants weighing 1,000 grams or less at birth. Pediatrics 1975;56:112–115.

    CAS  PubMed  Google Scholar 

  26. Alexander GR, Kogan MD, Nabukera S . Racial differences in prenatal care use in the United States: Are disparities decreasing? Am J Public Health 2002;92:1970–1975.

    Article  Google Scholar 

  27. Escarce JJ, Epstein KR, Colby DC, Schwartz JS . Racial differences in the elderly's use of medical procedures and diagnostic tests. Am J Public Health 1993;83:948–954.

    Article  CAS  Google Scholar 

  28. Cornelius L . Barriers to medical care for white, black, and Hispanic American children. J Natl Med Assoc 1993;85:281–288.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Halfon N, Newacheck PW, Wood DL, St Peter RF . Routine emergency department use for sick care by children in the United States. Pediatrics 1996;98:28–34.

    CAS  PubMed  Google Scholar 

  30. Weitzman M, Byrd RS, Auinger P . Black and white middle class children who have private health insurance in the United States. Pediatrics 1999;104:151–157.

    CAS  PubMed  Google Scholar 

  31. Broyles S, Tyson JE, Heyne ET, et al. Comprehensive followup care and life threatening illnesses among high-risk infants. JAMA 2000;284:2070–2076.

    Article  CAS  Google Scholar 

  32. Johnson YR, Shankaran S, Yao Q, Wright LL, Vohr B, Fanaroff AA, for Neonatal Research Network. Risk factors associated with postneonatal mortality among extremely low birth weight infants. Pediatr Res 2002;4:A1693.

    Google Scholar 

  33. The Impact-RSV Study Group. Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. Pediatrics 1998;102:531–537.

Download references

Acknowledgements

This work was funded by National Institute of Child Health and Human Development Grants U10 HD21397, U10 HD34216, U10 HD27853, U10 HD27871, U10 HD21364, U10 HD21415, U10 HD40689, U10 HD27856, U10 HD27904, U10 HD27881, U01 HD36790, U10 HD21385, U10 HD27880, U10 HD27851, U10 HD 21373, and General Clinical Research Center Grants M01 RR 08084, M01 RR 06022, M01 RR 00750, M01 RR 00997, M01 RR 00070. National Institute of Child Health and Human Development Neonatal Research Network Followup Principle Investigators 1998 to 2000:

Betty Vohr, MD — Chairman, Brown University

Dee Wilson-Costello, MD — Case Western Reserve University

Jean Steichen, MD — University of Cincinnati

Neal Simon, MD — Barbara Stoll, MD — Emory University

Anna Dusick, MD — Indiana University

Charles Bauer, MD — University of Miami

LuAnn Papile, MD — University of New Mexico

Susan Hintz, MD — Stanford University

Henrietta Bada, MD — University of Tennessee, Memphis

Sue Broyles, MD — University of Texas Southwestern at Dallas

Brenda Morris, MD — University of Texas at Houston

Virginia Delaney-Black, MD/ Yvette Johnson, MD — Wayne State University

Richard Ehrenkranz, MD — Yale University

Author information

Authors and Affiliations

  1. Department of Paediatrics (B.H.M., K.K.), Center for Clinical Research and Evidence Based Medicine, Houston, TX, USA

    Brenda H Morris MD & Kathleen Kennedy MD, MPH

  2. (K.K.), University of Texas Medical School at Houston, Houston, TX, USA

    Kathleen Kennedy MD, MPH

  3. RTI International (C.C.G.), Rockville, MD, USA

    Charlotte C Gard MS

Authors
  1. Brenda H Morris MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charlotte C Gard MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kathleen Kennedy MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

For the NICHD Neonatal Research Network

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morris, B., Gard, C., Kennedy, K. et al. Rehospitalization of Extremely Low Birth Weight (ELBW) Infants: Are There Racial/Ethnic Disparities?. J Perinatol 25, 656–663 (2005). https://doi.org/10.1038/sj.jp.7211361

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211361

This article is cited by

Search

Advanced search

Quick links