RESUMO
OBJECTIVES: To determine the effects of human milk and social/environmental disparities on developmental outcomes of infants born preterm cared for in a single-family room (SFR) neonatal intensive care unit (NICU). STUDY DESIGN: Outcomes were compared between infants weighing ?1250 g cared for in an open-bay NICU (1/2007-8/2009) (n?=?394) and an SFR NICU (1/2010-12/2011) (n?=?297). Human milk provision at 1 week, 4 weeks and discharge, and 4 week volume (mL/kg/day) were analyzed. At 18-24 months of age, the Bayley III was administered. Group differences were evaluated and multiple linear regression analyses were run. RESULTS: Infants cared for in the SFR NICU had higher Bayley III cognitive and language scores, higher rates of human milk provision at 1 and 4 weeks, and higher human milk volume at 4 weeks. In adjusted regression models, the SFR NICU was associated with a 2.55-point increase in Bayley cognitive scores and 3.70-point increase in language scores. Every 10?mL/kg/day increase of human milk at 4 weeks was independently associated with increases in Bayley cognitive, language, and motor scores (0.29, 0.34, and 0.24, respectively). Medicaid was associated with decreased cognitive (?4.11) and language (?3.26) scores, and low maternal education and non-white race with decreased language scores (?4.7 and ?5.8, respectively). Separate models by insurance status suggest there are differential benefits from SFR NICU and human milk between infants with Medicaid and private insurance. CONCLUSIONS: Infants born preterm cared for in the SFR NICU have higher Bayley language and cognitive scores and receive more human milk. Independent effects on outcomes were derived from SFR NICU, provision of human milk, and social and environmental factors.
Assuntos
Desenvolvimento Infantil , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/organização & administração , Leite Humano , Adulto , Alimentação com Mamadeira , Aleitamento Materno , Pré-Escolar , Escolaridade , Feminino , Seguimentos , Arquitetura Hospitalar , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Tempo de Internação , Masculino , Medicaid , Quartos de Pacientes , Estudos Prospectivos , Grupos Raciais , Estados Unidos , Aumento de PesoRESUMO
OBJECTIVES: To evaluate the effects of a transition home program on 90-day rehospitalization rates of preterm (PT) infants born at <37 weeks gestational age implemented over 3 years for infants with Medicaid and private insurance, and to identify the impact of social/environmental and medical risk factors on rehospitalization. STUDY DESIGN: In this prospective cohort study of 954 early, moderate, and late PT infants, all families received comprehensive transition home services provided by social workers and family resource specialists (trained peers) working with the medical team. Rehospitalization data were obtained from a statewide database and parent reports. Group comparisons were made by insurance type. Regression models were run to identify factors associated with rehospitalization and duration of rehospitalization. RESULTS: In bivariable analyses, Medicaid was associated with more infants hospitalized, more than 1 hospitalization, and more days of hospitalization. Early PT infants had more rehospitalizations by 90 days than moderate (P = .05) or late PT infants (P = .01). In regression modeling, year 3 of the transition home program vs year 1 was associated with a lower risk for rehospitalization by 90 days (OR, 0.57; 95% CI, 0.36-0.93; P = .03). Medicaid (P = .04), non-English-speaking (P = .02), multiple pregnancies (P = .05), and bronchopulmonary dysplasia (P = .001) were associated with increased risk. Both bronchopulmonary dysplasia and Medicaid were associated with increased days of rehospitalization in adjusted analyses. The major cause of rehospitalization was respiratory illness (61%). CONCLUSIONS: Transition home prevention strategies must be directed at both social/environmental and medical risk factors to decrease the risk of rehospitalization.