Hospitalizations during infancy in three population-based studies in Southern Brazil: trends and differentials

Hospital admissions in the first year of life: inequalities over three decades in a southern Brazilian city

BACKGROUND

Hospital admissions in infancy are declining in several countries. We describe admissions to neonatal intensive care units (NICU) and other hospitalizations over a 33-year period in the Brazilian city of Pelotas.

METHODS

We analysed data from four population-based birth cohorts launched in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. NICU and other hospital admissions during infancy were reported by the mothers in the perinatal interview and at the 12-month visit, respectively. We describe these outcomes by sex of the child, family income and maternal skin colour.

RESULTS

In 1982, NICUs did not exist in the city; admissions into NICUs increased from 2.7% of all newborns in 1993 to 6.7% in 2015, and admission rates were similar in all income groups. Hospitalizations during the first year of life fell by 29%, from 23.7% in 1982 to 16.8% in 2015, and diarrhoea admissions fell by 95.2%. Pneumonia admissions fell by 46.3% from 1993 to 2015 (no data available for 1982). Admissions due to perinatal causes increased during the period. In the poorest income quintile, total admissions fell by 33% (from 35.7% to 23.9%), but in the richest quintile these remained stable at around 10%, leading to a reduction in inequalities. Over the whole period, children born to women with black or brown skin were 30% more likely to be admitted than those of white-skinned mothers.

CONCLUSIONS

Whereas NICU admissions increased, total admissions in the first year of life declined by nearly one-third. Socioeconomic disparities were reduced, but important gaps remain.

Hospitalization in the first years of life and development of psychiatric disorders at age 6 and 11: a birth cohort study in Brazil

This study aimed to evaluate the medium-term effects that hospitalization in the first 48 months of life has on the development of psychiatric disorders at 6 and 11 years of age among individuals in a birth cohort in a middle-income country. We analyzed data from a 2004 birth cohort (N = 4,231) in the city of Pelotas, Rio Grande do Sul State, Brazil. The frequency of hospitalization was investigated at 12, 24 and 48 months of life. When the children were 6 and 11 years old, psychiatric disorders were investigated with the Development and Well-Being Assessment. We used logistic regression to adjust for potential confounders. The overall frequency of hospitalization during the first 48 months of life was 33.1% (95%CI: 31.4; 34.7). Among the hospitalized children 25.6% (95%CI: 24.1; 27.1), 4.7% (95%CI: 4.0; 5.5) and 2.8% (95%CI: 2.3; 3.5) were hospitalized 1, 2 or ≥ 3 times during this period, respectively. After adjustment for potential confounders, the chance of presenting any psychiatric disorder at 6 and 11 years of age was higher for the children who had been hospitalized during the first 48 months of life than for those who had not, with OR of 1.50 (95%CI: 1.19; 1.88) and 1.63 (95%CI: 1.28; 2.07), respectively. Our results support the hypothesis that hospitalization in the early stages of life has an effect on the subsequent mental health of children. Preventive measures are needed in order to minimize the negative experiences of children who are hospitalized during infancy.

Characteristics and factors associated with hospitalization in early childhood: 2004 Pelotas (Brazil) birth cohort

Hospitalization is a frequent event in early childhood. In Brazil, the National Household Sample Survey of 2008 showed a 9% hospitalization rate among children in the first four years of life. The study aimed to describe the characteristics of hospitalization in the first six years of life and analyze the early factors associated with hospitalization in a birth cohort in southern Brazil. A zero-inflated Poisson model was used to simultaneously examine the effects of co-variables for the occurrence of a given event and to count events. The frequency of at least one episode of hospitalization during the study period was 33.4% (95%CI: 31.8-34.9), and was highest in the first year (19.1%; 95%CI: 17.9-20.4), remaining stable at approximately 10% between the first and fourth years, decreasing to 8.4% (95%CI: 7.6-9.4) between the fourth and sixth years. diseases of the respiratory system were among the leading causes of hospitalization, followed by infectious and parasitic diseases. History of prior hospitalization was one of the most important predictors of odds of hospitalization and risk of multiple hospitalizations. In early childhood, birth weight, gestational age, Apgar score, sex, and type of pregnancy were inversely associated with hospitalization, and environmental characteristics such as maternal smoking in pregnancy, mother's skin color, and low family income were associated statistically with number of hospitalizations. The results point to the importance of focusing efforts on reducing hospitalizations from diseases of the respiratory system, especially in children under one year.

Factors associated with avoidable hospitalisation of children younger than 2 years old: the 2006 Brazilian National Demographic Health Survey

Introduction

Ambulatory Care Sensitive Conditions (ACSC) are conditions for which hospitalisation is thought to be avoidable with the use of effective preventive care and early disease management. The objective of this study was to estimate the rate of avoidable hospitalisations in children younger than 24 months of age participating in a Brazilian national representative survey and to identify the risk factors for such hospitalisations.

Methods

We analysed data from a cross-sectional study of 1901 children from the 2006 Brazilian National Demographic Health Survey of Women and Children (NDHS). The children’s socioeconomic, biological and maternal characteristics, nutritional status, and access to healthcare were tested; variables with p < 0.20 were selected to fit a Poisson regression.

Results

The prevalence of avoidable hospitalisation was 11.8 % (95 % Confidence Interval [CI], 9.0, 15.2); the prevalence was higher in the Southeast (40.1 %) and Northwest (21.7 %) macro-regions. The multivariate model identified five risk factors for avoidable hospitalisation: male gender (Prevalence Ratio [PR] = 1.48, p = 0.004), low socioeconomic level (PR = 1.51, p = 0.005), children from mothers younger than 20 years of age (PR = 1.41, p = 0.031), not breastfed within the first hour of life (PR = 1.29, p = 0.034), and neonatal hospitalisation (PR = 1.66, p = 0.043).

Conclusions

To decrease the costs associated with avoidable hospitalisations, health managers and professionals should focus their efforts on providing effective primary healthcare to families of low socioeconomic levels, particularly prenatal and paediatric care, as well as encouraging breastfeeding and supporting young mothers. Strategies to improve children’s health by controlling such hospitalisations in Brazil should consider all residence areas and geopolitical macro-regions.

Associated factors for accelerated growth in childhood: a systematic review

Several studies have shown that accelerated growth in the postnatal period is critical for the development of chronic diseases. The term catch-up has been used for the accelerated growth of children who have suffered some sort of restriction of nutrition or oxygen supply. However, accelerated growth has been observed among children who have an appropriate birth weight for their gestational age (AGA) and with no apparent morbidity. Therefore, this systematic review was carried out on the associated factors of accelerated growth, or catch-up, using the Medline/Pubmed database. Only cohort studies written in Portuguese, English or Spanish, with children between zero and 12 years old who presented accelerated growth or catch-up as the outcome were included. Out of the 2,155 articles found, 9 were selected. There is no uniformity in the operational definition of accelerated growth, or in the concept of catch-up. According to this review, accelerated growth is associated with primiparity, maternal smoking during pregnancy, lower birth weight, and early weaning. The main limitations in the available literature are the high number of follow-up losses and the lack of control for confounding factors. The determinants of accelerated growth still need to be studied further, especially among AGA children.

Motor delay in cystic fibrosis infants: an observational study

OBJECTIVE

To verify the prevalence of delay in gross motor development in cystic fibrosis (CF) patients.

STUDY DESIGN

This is a cross-sectional observational study. A total of 15 children with CF were included in the analyses. The selection criteria was age between 6 and 42months. Data on demographic, anthropometric, clinical characteristics and severity score (Shwachman) were obtained from patient records. The Bayley Scales of Infant and Toddler Development® - III Edition (BSITD-III) was used to assess motor abilities.

RESULTS

Motor development delay was observed in 26.7% (n=4) of the children and, in 75% of these, there were statistically significant differences between gross and fine motor scores. Low stature, low weight and periods longer than 60days at hospital showed statistically significant association with motor delay (p=0.025, 0.032, 0.003, respectively).

CONCLUSION

The prevalence of motor delay in the studied sample was high, suggesting that biological and ambient conditions of risk present in CF contribute to early motor deficits. Thus, the observation of the motor development in these patients is important for planning an adequate intervention.

CE, Tavares FG. Morbidade hospitalar indígena Guarani no Sul e Sudeste do Brasil

Estudos sobre morbidade hospitalar em povos indígenas no Brasil são relativamente recentes, restritos quanto à cobertura e carecem de fontes de dados capazes de gerar indicadores por etnia. Esse estudo descreve a morbidade hospitalar indígena na população residente em 83 aldeias Guarani no Sul e Sudeste do Brasil (N = 6.483), a partir de dados primários obtidos em um sistema de vigilância de hospitalizações implantado em 2007/2008, especificamente para um estudo caso-controle sobre infecção respiratória aguda (IRA) em crianças Guarani. No período, ocorreram 666 hospitalizações concentradas em 497 indivíduos, sendo a maioria em < 5 anos (71,9%). As doenças respiratórias foram as principais causas de hospitalização (64,6%), sobretudo em crianças (< 5 anos: 77,6%; < 1 ano: 83,4%), superando as magnitudes das proporções de hospitalização por essas causas em outros grupos indígenas. A taxa de hospitalização (por 100 pessoas-ano) global foi de 8,8, correspondendo a 71,4 em < 1 ano e a 21,0 entre 1 e 4 anos. A taxa de hospitalização por IRA (5,3) superou em 6,5 e 2,0 vezes àquelas por diarréia e por demais causas, enquanto em < 5 anos (IRA = 23,7), essas razões de taxas foram de 7,4 e 5,4, respectivamente. A taxa padronizada de hospitalização Guarani superou as taxas padronizadas das regiões Sul e Sudeste em 40% e 210%, respectivamente. As hospitalizações marcadas por condições sensíveis à atenção primária e a magnitude das IRA indicam que, além de estudos para compreender a epidemiologia das IRA, são necessários investimentos na qualificação da atenção primária à saúde Guarani.

Maternal-child health in Pelotas, Rio Grande do Sul State, Brazil: major conclusions from comparisons of the 1982, 1993, and 2004 birth cohorts

Important changes were observed in maternal characteristics, health care indicators, and child health during the 22 years covered by the three population-based birth cohort studies conducted in the city of Pelotas, Southern Brazil. Maternal education levels improved, cigarette smoking during pregnancy was reduced, and birth intervals became longer. Also, there were more single mothers, and maternal obesity increased. Coverage of antenatal and delivery care by professionals improved, but inductions and caesarean sections increased markedly, the latter accounting for 45% of deliveries in 2004. With regard to child health, the reductions in neonatal and infant mortality rates were modest, and the significant increase in preterm births--14.7% of all births in 2004--appears to have colluded with this stagnation. Other infant health indicators, such as immunization coverage and breastfeeding duration, showed improvements over the period. Regarding infant nutrition, malnourishment at age 12 months decreased, but the prevalence of overweight was higher in 2004. The existence of three population-based birth cohorts using comparable methodology allowed for the study of important secular trends in maternal and child health.

Breastfeeding and feeding patterns in three birth cohorts in Southern Brazil: trends and differentials

Breastfeeding is fundamental for child health. Changes in the duration of breastfeeding are compared for three population-based cohorts of children born in 1982, 1993 and 2004 in the city of Pelotas, Southern Brazil. Samples of the 1982 and 1993 children and all of the children from the 2004 cohort study were sought at home when they were aged around 12 months. Both the duration of breastfeeding and the stage at which different kind of foods were regularly introduced were investigated. The median duration of breastfeeding increased from 3.1 to 6.8 months in this period. Exclusive breastfeeding at three months was practically non-existent in 1982 and had reached one third of infants by 2004. The increase was faster after 1993, suggesting an important impact made by promotion activities. Up to about 6-9 months, breastfeeding was more prevalent in high-income families, but after this age it became more common among the poor. Low birth weight babies were breastfeed for shorter durations. The duration of breastfeeding is still far short of international recommendations, justifying further campaigns. Special attention should be given to low birth weight babies and those from low-income families.