Abstract
BackgroundAdmissions of infants in England have increased substantially but there is little evidence whether this is across the first year or predominately in neonates; and for all or for specific causes. We aimed to characterise this increase, especially those admissions that may be avoidable in the context of postnatal care provision.MethodsA cross sectional analysis of 1,387,677 infants up to age one admitted to English hospitals between April 2008 and April 2014 using Hospital Episode Statistics and live birth denominators for England from Office for National Statistics. Potentially avoidable conditions were defined through a staged process with a panel.ResultsThe rate of hospital admission in the first year of life for physiological jaundice, feeding difficulties and gastroenteritis, the three conditions identified as potentially preventable in the context of postnatal care provision, increased by 39% (39.55 to 55.33 per 1000 live births) relative to an overall increase of 6% (334.97 to 354.55 per 1000 live births). Over the first year the biggest increase in admissions occurred in the first 0–6 days (RR 1.26, 95% CI 1.24 to 1.29) and 85% of the increase (12.36 to 18.23 per 1000 live births) in this period was for the three potentially preventable conditions.ConclusionsMost of the increase in infant hospital admissions was in the early neonatal period, the great majority being accounted for by three potentially avoidable conditions especially jaundice and feeding difficulties. This may indicate missed opportunities within the postnatal care pathway and given the enormous NHS cost and parental distress from hospital admission of infants, requires urgent attention.
Highlights
Admissions of infants in England have increased substantially but there is little evidence whether this is across the first year or predominately in neonates; and for all or for specific causes
The overall rate of admission increased significantly over the period from 335·0 to 354·6 per 1000 live births (Table 1)
The increase in admissions was most marked for the 0–6 day age category where admission rate increased from 26·39 per 1000 live births in 2008/09 to 33·31 per 1000 live births in 2013/14 (P < 0.0001)
Summary
Admissions of infants in England have increased substantially but there is little evidence whether this is across the first year or predominately in neonates; and for all or for specific causes. Especially emergency ones place a huge cost on health services [1, 2] and there is evidence from studies using Hospital Episode Statistics (HES) data for England that emergency admissions of children have increased substantially. In children under 15 between 1999 and 2010 in England all emergency admissions increased with the greatest increase in infants: in 2010 over a third of infants had an admission some time in their first year [3]. A study of infant admission in England using HES data showed that between 2005 and 2014, 5.2% of infants were readmitted unexpectedly within 30 days of postnatal discharge and that the risk of readmission increased by 4.4% annually from 4.4% in 2005 to 6.3% in 2014 [5]. Whilst similar trends have been observed in Scotland [6] in the United States and Canada the proportion of hospital
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