Access to home apnea monitoring and its impact on rehospitalization among very-low-birth-weight infants
M. H. Malloy and B. Graubard
Department of Pediatrics, University of Texas Medical Branch, Galveston.
OBJECTIVE: To examine the relationship between home apnea monitoring and
sociodemographic, socioeconomic, and medical factors and the risk for
rehospitalization among very-low-birth-weight infants (birth weight <
1500 g). DESIGN AND SETTING: Analysis of live infants born weighing less
than 1500 g; these data were obtained from the 1988 National Maternal and
Infant Health Survey. Data from this survey were obtained by maternal
questionnaires and from birth certificates and medical records. OUTCOME
MEASURE: One or more hospitalizations after discharge from the hospital of
delivery. RESULTS: Home apnea monitor use was strikingly lower among black
infants (19.8%) compared with nonblack infants (43.7%) (P < .001). The
rate of rehospitalization for blacks was 24.8%, which was lower than the
rate of 34.3% for nonblacks (P = .001). Neither annual family income nor
method of hospital payment was associated with rehospitalization. The use
of an apnea monitor in the home was associated with an increased odds ratio
for rehospitalization for both blacks (odds ratio, 2.56; 95% confidence
interval, 1.56 to 4.21) and nonblacks (odds ratio, 2.28; 95% confidence
interval, 1.51 to 3.45). With adjustment for the use of an apnea monitor,
the odds ratio for rehospitalization of blacks vs nonblacks was no longer
significant (odds ratio, 0.80; 95% confidence interval, 0.60 to 1.08).
CONCLUSIONS: The use of an apnea monitor in the home was highly associated
with an increased risk for rehospitalization. Whether this increased risk
was attributable to a valid reason for rehospitalization or to closer
scrutiny of the infant could not be determined. The lower prevalence of
apnea monitor use among blacks is unexplained.
