title: Health care utilization in the first year of life among small- and large- for-gestational age term infants.
abstract: 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 ≥5 nights during the delivery hospitalization; of those born vaginally, SGA infants had 1.5 higher adjusted odds [95 % 1.1, 2.1] of staying ≥4 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 ≥4 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.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS K-22, Atlanta, GA 30341, USA. PAD8@cdc.gov
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Dietz
authors.forename: Joanne H
authors.initials: JH
authors.lastname: Rizzo
authors.forename: Lucinda J
authors.initials: LJ
authors.lastname: England
authors.forename: William M
authors.initials: WM
authors.lastname: Callaghan
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Vesco
authors.forename: F Carol
authors.initials: FC
authors.lastname: Bruce
authors.forename: Joanna E
authors.initials: JE
authors.lastname: Bulkley
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Sharma
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
mesh_terms: D000293:Adolescent; D000328:Adult; D002662:Child Health Services / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005320:Fetal Macrosomia; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D009922:Oregon; D011247:Pregnancy; D011256:Pregnancy Outcome; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States; D014861:Washington; D055815:Young Adult