Health Care Utilization in the First Year of Life among Small- and Large- for-Gestational Age Term Infants
Health Care Utilization in the First Year of Life among Small- and Large- for-Gestational Age Term Infants
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DOI：
10.1007/s10995-012-1082-z
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发表时间：
2013-08-01
影响因子：
2.3
通讯作者：
Hornbrook, Mark C.
中科院分区：
文献类型：
--
作者：
Dietz, Patricia M.;Rizzo, Joanne H.;Hornbrook, Mark C.
该研究的目的是评估小于胎龄和大于胎龄的足月儿在出生后第一年是否有更多的医疗保健利用率。样本包括 1998 年至 2007 年期间出生的 28,215 名无重大出生缺陷的单胎足月婴儿（37-42 周），并在出生后 12 个月内连续在 Kaiser Permanente Northwest 入组。相对胎龄的出生体重分为 3 个级别：< 10% (SGA)、10-90% (AGA)、> 90% (LGA)。从电子记录中获得分娩住院时间、再次住院时间和病房/急诊室就诊时间。逻辑回归模型估计了出生体重类别与再住院之间的关联。广义线性模型估计调整后的平均生病/紧急就诊次数。足月儿中，6.2%为SGA，13.9%为LGA。在剖腹产出生的婴儿中，SGA 婴儿在分娩住院期间住院 5 晚的几率比 AGA 婴儿高 2.7 [95% 1.9, 3.8]；在顺产婴儿中，SGA 婴儿以千分之一日元的价格入住 4 晚的调整后赔率高出 1.5 倍 [95% 1.1, 2.1]。与 AGA 婴儿相比，LGA 婴儿在分娩后 2 周内再次住院的几率较高 [OR 1.25, 95% CI 0.99, 1.58]，并且住院期间住院时间为千分之一日元 4 天 [OR 2.6, 95% CI 1.3, 5.0]。 SGA 婴儿的调整后平均就诊/急诊次数 (7.8) 略高于 AGA (7.5) 婴儿 (P < .05)。出生于 SGA 或 LGA 的足月婴儿的医疗保健利用率高于同龄婴儿，尽管在初次分娩住院后的利用率增幅很小。
The objective of the study was to assess if small- and large-for gestational age term infants have greater health care utilization during the first year of life. The sample included 28,215 singleton term infants (37-42 weeks) without major birth defects delivered from 1998 through 2007 and continuously enrolled at Kaiser Permanente Northwest for 12 months after delivery. Birth weight for gestational age was categorized into 3 levels: < 10th percentile (SGA), 10-90th percentile (AGA), > 90th percentile (LGA). Length of delivery hospitalization, re-hospitalizations and sick/emergency room visits were obtained from electronic records. Logistic regression models estimated associations between birth weight category and re-hospitalization. Generalized linear models estimated adjusted mean number of sick/emergency visits. Among term infants, 6.2 % were SGA and 13.9 % were LGA. Of infants born by cesarean section, SGA infants had 2.7 higher odds [95 % 1.9, 3.8] than AGA infants of staying a parts per thousand yen5 nights during the delivery hospitalization; of those born vaginally, SGA infants had 1.5 higher adjusted odds [95 % 1.1, 2.1] of staying a parts per thousand yen4 nights. LGA compared to AGA infants had higher odds of re-hospitalization within 2 weeks of delivery [OR 1.25, 95 % CI 0.99, 1.58] and of a length of stay a parts per thousand yen4 days during that hospitalization [OR 2.6, 95 % CI 1.3, 5.0]. The adjusted mean number of sick/emergency room visits was slightly higher in SGA (7.8) than AGA (7.5) infants (P < .05). Term infants born SGA or LGA had greater health care utilization than their counterparts, although the increase in utilization beyond the initial delivery hospitalization was small.