Rehospitalization of extremely low birth weight (ELBW) infants: are there racial/ethnic disparities?

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.