 |
|
Rehospitalization for Neonatal Dehydration
A Nested Case-Control Study
Gabriel J. Escobar, MD;
Veronica M. Gonzales, BS;
Mary Anne Armstrong, MA;
Bruce F. Folck;
Blong Xiong, MPH;
Thomas B. Newman, MD, MPH
Arch Pediatr Adolesc Med. 2002;156:155-161.
Objectives To determine the incidence of neonatal dehydration leading to rehospitalization,
whether clinical and health services data could predict its occurrence, and
the outcome of dehydrated infants.
Methods We employed a retrospective case-control design nested within a cohort
of 51 383 newborns weighing 2000 g or more, with a gestational age of
36 weeks or more born at 11 Kaiser Permanente hospitals during 1995 and 1996.
Cases were 110 infants who were rehospitalized within 15 days of discharge
with dehydration, and who either had 12% or greater weight loss or a serum
sodium level of 150 mEq/L or greater. Controls were 402 randomly selected
infants. We reviewed subjects' paper medical records and telephoned their
families at 24 to 36 months of age to ascertain neurological outcomes.
Results Rehospitalization for dehydration occurred in 2.1 per 1000 live births
(95% confidence interval [CI], 1.8-2.6). Among vaginal births, the most important
risk factors were being born of a first-time mother (adjusted odds ratio [AOR],
5.5; 95% CI, 3.1-9.6); exclusive breastfeeding (AOR, 11.2; 95% CI, 3.9-32.6);
maternal age equal to or older than 35 years (AOR, 3.0; 95% CI, 1.5-6.0);
and gestational age younger than 39 weeks (AOR, 2.0, 95% CI, 1.2-3.5). Among
cesarean births, having a birth hospitalization length of stay less than 48
hours was associated with dehydration (odds ratio [OR], 14.8; 95% CI, 1.4-154.1).
Adherence to the American Academy of Pediatrics follow-up guideline did not
decrease risk of readmission. Among surviving infants, 1 of 110 cases and
12 of 400 controls had evidence of possible neurological problems 24 to 36
months after discharge (P = .3). No cases of limb
gangrene, amputation, or intracranial infarction occurred.
Conclusions In this population with good access to medical care, serious sequelae
of neonatal dehydration are rare. Interventions to decrease the frequency
of neonatal dehydration should focus on first-time mothers and those who breastfeed
exclusively.
From the Division of Research, Perinatal Research Unit, Kaiser Permanente
Medical Care Program, Oakland, Calif (Dr Escobar, Mss Gonzales and Armstrong,
Mr Folck, and Mr Xiong); the Perinatal Research Unit, Kaiser Permanente Medical
Center, Walnut Creek, Calif (Dr Escobar); and the Departments of Epidemiology
and Biostatistics, Pediatrics, and Laboratory Medicine, University of California,
San Francisco (Dr Newman).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Late-Preterm Births: Challenges and Opportunities
Raju
Pediatrics 2008;121:402-403.
FULL TEXT
Effect of Late-Preterm Birth and Maternal Medical Conditions on Newborn Morbidity Risk
Shapiro-Mendoza et al.
Pediatrics 2008;121:e223-e232.
ABSTRACT
| FULL TEXT
"Late-Preterm" Infants: A Population at Risk
Engle et al.
Pediatrics 2007;120:1390-1401.
ABSTRACT
| FULL TEXT
Preventable Newborn Readmissions Since Passage of the Newborns' and Mothers' Health Protection Act
Paul et al.
Pediatrics 2006;118:2349-2358.
ABSTRACT
| FULL TEXT
Optimizing Care and Outcome for Late-Preterm (Near-Term) Infants: A Summary of the Workshop Sponsored by the National Institute of Child Health and Human Development
Raju et al.
Pediatrics 2006;118:1207-1214.
ABSTRACT
| FULL TEXT
Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit
Escobar et al.
Arch. Dis. Child. Fetal Neonatal Ed. 2006;91:F238-F244.
ABSTRACT
| FULL TEXT
Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more.
Newman et al.
NEJM 2006;354:1889-1900.
ABSTRACT
| FULL TEXT
Index of Suspicion in the Nursery
Ramirez et al.
NeoReviews 2005;6:e399-e402.
FULL TEXT
Rehospitalisation after birth hospitalisation: patterns among infants of all gestations
Escobar et al.
Arch. Dis. Child. 2005;90:125-131.
ABSTRACT
| FULL TEXT
Cost-Effectiveness of Postnatal Home Nursing Visits for Prevention of Hospital Care for Jaundice and Dehydration
Paul et al.
Pediatrics 2004;114:1015-1022.
ABSTRACT
| FULL TEXT
Alcohol & Drug Abuse: The Best of Practices, the Worst of Practices: The Making of Science-Based Primary Prevention Programs
Gorman
Psychiatr. Serv. 2003;54:1087-1089.
FULL TEXT
Clinician Support and Psychosocial Risk Factors Associated With Breastfeeding Discontinuation
Taveras et al.
Pediatrics 2003;112:108-115.
ABSTRACT
| FULL TEXT
Jaundice Noted in the First 24 Hours After Birth in a Managed Care Organization
Newman et al.
Arch Pediatr Adolesc Med 2002;156:1244-1250.
ABSTRACT
| FULL TEXT
|
