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March 1995, Vol 149, No. 3 >
Article | March 1995

Access to Home Apnea Monitoring and Its Impact on Rehospitalization Among Very-Low-Birth-Weight Infants FREE

Michael H. Malloy, MD, MS; Barry Graubard, PhD
Arch Pediatr Adolesc Med. 1995;149(3):326-332. doi:10.1001/archpedi.1995.02170150106021.
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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 <1500g).

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.(Arch Pediatr Adolesc Med. 1995;149:326-332)

REFERENCES

1 +
Glass L, Kolko N, Evans H.  Factors influencing predisposition to serious illness in low birth weight infants . Pediatrics . 1971;;48:368-371.
2 +
Outerbridge EW, Nogrady MB, Beaudry PH, Stern L.  Idiopathic respiratory distress syndrome: recurrent respiratory illness in survivors . AJDC . 1972;:123: 99-104.
3 +
McCormick MC, Shapiro S, Starfield BH.  Rehospitalization in the first year of life for high-risk survivors . Pediatrics . 1980;;66:991-999.
4 +
Hack M, DeMonterice D, Merkatz IR, Jones P, Fanaroff A.  Rehospitalization of the very-low-birth-weight infant: a continuum of perinatal and environmental morbidity . AJDC . 1981;;135:263-266.
5 +
Yu VY, Orgill AA, Lim SB, Bajuk B, Astbury J.  Growth and development of very low birth weight infants recovering from bronchopulmonary dysplasia . Arch Dis Child . 1983;;58:791-794.
6 +
Combs-Orme T, Fishbein J, Summerville C, Evans MG.  Rehospitalization of very-low-birth-weight infants . AJDC . 1988;;142:1109-1113.
7 +
Bowman E, Yu VYH.  Continuing morbidity in extremely low birthweight infants . Early Hum Dev . 1989;;18:165-174.
8 +
Kitchen WH, Ford GW, Doyle LW, Rickards AL, Kelly EA.  Health and hospital readmissions of very-low-birth-weight and normal-birth-weight children . AJDC . 1990;;144:2213-2218.
9 +
Cunnningham CK, McMillan JA, Gross SJ.  Rehospitalization for respiratory illness in infants of less than 32 weeks' gestation . Pediatrics . 1991;;88:527-532.
10 +
Kelly DH, Shannon DC, O'Connell K.  Care of infants with near-miss sudden infant death syndrome . Pediatrics . 1978;;61:511-514.
11 +
American Academy of Pediatrics.  Task Force on Prolonged Apnea . Pediatrics . 1978;;61:651-652.
12 +
Duffty P, Bryan MH.  Home apnea monitoring in 'near-miss' sudden infant death syndrome (SIDS) and siblings of SIDS victims . Pediatrics . 1982;;70:69-74.
13 +
American Academy of Pediatrics.  Task Force on Prolonged Infantile Apnea: 1985 . Pediatrics . 1985;;76:129-131.
14 +
Peterson DR.  Sudden unexpected death in infants: an epidemiologic study . Am J Epidemiol . 1966;;84:478-482.
15 +
Standfast SJ, Jereb S, Janerich DT.  The epidemiology of sudden infant death in upstate New York, II: birth characteristics . Am J Public Health . 1980;;70: 1061-1067.
16 +
National Institutes of Health.  Consensus Development Conference on Infantile Apnea and Home Monitoring, Sept 29 to Oct 1, 1986 . Pediatrics . 1987;;79: 292-300.
17 +
National Center for Health Statistics. 1988 National Maternal and Infant Health Survey [public use data tape] . Washington, DC: Public Health Service; 1991;.
18 +
Sanderson M, Placek PJ, Keppel KG.  The 1988 National Maternal and Infant Health Survey: design, content, and data availability . Birth . 1991;;18:26-32.
19 +
Sauve RS, Singhal N.  Long-term morbidity of infants with bronchopulmonary dysplasia . Pediatrics . 1985;;76:725-733.
20 +
Cain LP, Kelly DH, Shannon DC.  Parents' perceptions of the psychological and social impact of home monitoring . Pediatrics . 1980;;66:37-41.
21 +
Markstead T, Fitzhardinge PM.  Growth and development in children recovering from bronchopulmonary dysplasia . J Pediatr . 1981;;98:597-602.
22 +
Wasserman AL.  A prospective study of the impact of home monitoring on the family . Pediatrics . 1984;;74:323-329.
23 +
McElroy E, Steinschneider A, Weinstein S.  Emotional and health impact of home monitoring on mothers: a controlled prospective study . Pediatrics . 1986;;78: 780-786.
24 +
Vohr BR, Chen A, Coll CG, Oh W.  Mothers of preterm and full-term infants on home apnea monitors . AJDC . 1988;;142:229-231.
25 +
Wilcox A, Russell I.  Why small black infants have a lower mortality rate than small white infants: the case for population-specific standards for birth weight . J Pediatr . 1990;;116:7-10.
26 +
Braveman PA, Egerter S, Bennett T, Showstack J.  Differences in hospital resource allocation among sick newborns according to insurance coverage . JAMA . 1991;;266:3300-3308.
27 +
Wise PH, Pursley D.  Infant mortality as a social mirror . N Engl J Med . 1992;; 326:1558-1560.
28 +
Hogue CJR, Hargraves MA.  Class, race, and infant mortality in the United States . Am J Public Health . 1993;;83:9-12
29 +
 US Congress, Office of Technology Assessment . Technology-Dependent Children: Hospital v Home Care: A Technical Memorandum . Washington, DC: US Government Printing Office; 1987;. Publication OTA-TM-H-38.
30 +
Damus K, Pakter J, Krongrad E, Standfast SJ, Hoffman HJ.  Postnatal medical and epidemiological risk factors for the sudden infant death syndrome . In: Harper RM, Hoffman HJ, eds. Sudden Infant Death Syndrome: Risk Factors and Basic Mechanisms . New York, NY: PMA Publishing Corp; 1988;:187-201.
31 +
Cunningham AS, Jelliffe DB, Jelliffe EFP.  Breast-feeding and health in the 1980s: a global epidemiologic review . J Pediatr . 1991;;118:659-666.

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References

1 +
Glass L, Kolko N, Evans H.  Factors influencing predisposition to serious illness in low birth weight infants . Pediatrics . 1971;;48:368-371.
2 +
Outerbridge EW, Nogrady MB, Beaudry PH, Stern L.  Idiopathic respiratory distress syndrome: recurrent respiratory illness in survivors . AJDC . 1972;:123: 99-104.
3 +
McCormick MC, Shapiro S, Starfield BH.  Rehospitalization in the first year of life for high-risk survivors . Pediatrics . 1980;;66:991-999.
4 +
Hack M, DeMonterice D, Merkatz IR, Jones P, Fanaroff A.  Rehospitalization of the very-low-birth-weight infant: a continuum of perinatal and environmental morbidity . AJDC . 1981;;135:263-266.
5 +
Yu VY, Orgill AA, Lim SB, Bajuk B, Astbury J.  Growth and development of very low birth weight infants recovering from bronchopulmonary dysplasia . Arch Dis Child . 1983;;58:791-794.
6 +
Combs-Orme T, Fishbein J, Summerville C, Evans MG.  Rehospitalization of very-low-birth-weight infants . AJDC . 1988;;142:1109-1113.
7 +
Bowman E, Yu VYH.  Continuing morbidity in extremely low birthweight infants . Early Hum Dev . 1989;;18:165-174.
8 +
Kitchen WH, Ford GW, Doyle LW, Rickards AL, Kelly EA.  Health and hospital readmissions of very-low-birth-weight and normal-birth-weight children . AJDC . 1990;;144:2213-2218.
9 +
Cunnningham CK, McMillan JA, Gross SJ.  Rehospitalization for respiratory illness in infants of less than 32 weeks' gestation . Pediatrics . 1991;;88:527-532.
10 +
Kelly DH, Shannon DC, O'Connell K.  Care of infants with near-miss sudden infant death syndrome . Pediatrics . 1978;;61:511-514.
11 +
American Academy of Pediatrics.  Task Force on Prolonged Apnea . Pediatrics . 1978;;61:651-652.
12 +
Duffty P, Bryan MH.  Home apnea monitoring in 'near-miss' sudden infant death syndrome (SIDS) and siblings of SIDS victims . Pediatrics . 1982;;70:69-74.
13 +
American Academy of Pediatrics.  Task Force on Prolonged Infantile Apnea: 1985 . Pediatrics . 1985;;76:129-131.
14 +
Peterson DR.  Sudden unexpected death in infants: an epidemiologic study . Am J Epidemiol . 1966;;84:478-482.
15 +
Standfast SJ, Jereb S, Janerich DT.  The epidemiology of sudden infant death in upstate New York, II: birth characteristics . Am J Public Health . 1980;;70: 1061-1067.
16 +
National Institutes of Health.  Consensus Development Conference on Infantile Apnea and Home Monitoring, Sept 29 to Oct 1, 1986 . Pediatrics . 1987;;79: 292-300.
17 +
National Center for Health Statistics. 1988 National Maternal and Infant Health Survey [public use data tape] . Washington, DC: Public Health Service; 1991;.
18 +
Sanderson M, Placek PJ, Keppel KG.  The 1988 National Maternal and Infant Health Survey: design, content, and data availability . Birth . 1991;;18:26-32.
19 +
Sauve RS, Singhal N.  Long-term morbidity of infants with bronchopulmonary dysplasia . Pediatrics . 1985;;76:725-733.
20 +
Cain LP, Kelly DH, Shannon DC.  Parents' perceptions of the psychological and social impact of home monitoring . Pediatrics . 1980;;66:37-41.
21 +
Markstead T, Fitzhardinge PM.  Growth and development in children recovering from bronchopulmonary dysplasia . J Pediatr . 1981;;98:597-602.
22 +
Wasserman AL.  A prospective study of the impact of home monitoring on the family . Pediatrics . 1984;;74:323-329.
23 +
McElroy E, Steinschneider A, Weinstein S.  Emotional and health impact of home monitoring on mothers: a controlled prospective study . Pediatrics . 1986;;78: 780-786.
24 +
Vohr BR, Chen A, Coll CG, Oh W.  Mothers of preterm and full-term infants on home apnea monitors . AJDC . 1988;;142:229-231.
25 +
Wilcox A, Russell I.  Why small black infants have a lower mortality rate than small white infants: the case for population-specific standards for birth weight . J Pediatr . 1990;;116:7-10.
26 +
Braveman PA, Egerter S, Bennett T, Showstack J.  Differences in hospital resource allocation among sick newborns according to insurance coverage . JAMA . 1991;;266:3300-3308.
27 +
Wise PH, Pursley D.  Infant mortality as a social mirror . N Engl J Med . 1992;; 326:1558-1560.
28 +
Hogue CJR, Hargraves MA.  Class, race, and infant mortality in the United States . Am J Public Health . 1993;;83:9-12
29 +
 US Congress, Office of Technology Assessment . Technology-Dependent Children: Hospital v Home Care: A Technical Memorandum . Washington, DC: US Government Printing Office; 1987;. Publication OTA-TM-H-38.
30 +
Damus K, Pakter J, Krongrad E, Standfast SJ, Hoffman HJ.  Postnatal medical and epidemiological risk factors for the sudden infant death syndrome . In: Harper RM, Hoffman HJ, eds. Sudden Infant Death Syndrome: Risk Factors and Basic Mechanisms . New York, NY: PMA Publishing Corp; 1988;:187-201.
31 +
Cunningham AS, Jelliffe DB, Jelliffe EFP.  Breast-feeding and health in the 1980s: a global epidemiologic review . J Pediatr . 1991;;118:659-666.

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