Perinatal risk factors for infant hospitalization with viral gastroenteritis.

R. D. Newman, J. Grupp-Phelan, D. K. Shay, Robert Davis

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

CONTEXT: A tetravalent vaccine against rotavirus, the most commonly identified etiologic agent of viral gastroenteritis (GE), has recently been licensed for use in the United States. OBJECTIVE: To evaluate whether specific groups of infants might be at sufficiently high risk to warrant a focused rotavirus vaccine policy, we investigated perinatal risk factors for hospitalization with viral GE and rotavirus in the first year of life. DESIGN: Population-based, case-control study. SETTING: Washington State linked birth certificate and hospital discharge abstracts from 1987 through 1995. PATIENTS: Infants, 1 through 11 months of age, hospitalized for viral GE (N = 1606) were patients in this study. Control subjects were 8084 nonhospitalized infants, frequency-matched to patients on year of birth. PRIMARY OUTCOME MEASURE: Maternal and infant characteristics associated with infant hospitalization for viral GE. RESULTS: We found a significant association between birth weight and the risk for hospitalization. Very low birth weight infants (<1500 g) were at the highest risk (odds ratio [OR] 2.6; 95% confidence interval [CI]: 1.6,4.1);, low birth weight infants (1500-2499 g), at intermediate risk (OR 1.6; 95% CI: 1.3,2.1); and large infants (>4000 g), at reduced risk (OR 0.8; 95% CI: 0.6,0.9). Other characteristics associated with GE hospitalization were male gender (OR 1.4; 95% CI: 1.3,1.6); maternal smoking (OR 1.2; 95% CI: 1.1,1. 4); unmarried mother (OR 1.2; 95% CI: 1.1,1.4); Medicaid insurance (OR 1.4; 95% CI: 1.3,1.7); and maternal age <20 years (OR 1.2; 95% CI: 1.0,1.5). Infants born October through December were at decreased risk for hospitalization (OR 0.8; 95% CI: 0.7,0.9), as were infants born to Asian mothers (OR 0.5; 95% CI: 0.3,0.7), and infants born to mothers >34 years of age (OR 0.7; 95% CI: 0.6,0.9). Using these factors, the area under a receiver operating characteristic curve was 0.63. Therefore, to achieve a sensitivity of 90% in identifying high-risk infants, specificity would fall to 10%. Subanalyses of children admitted for viral GE during the peak of the Northwest rotavirus season (January to March) and children with confirmed rotavirus infection demonstrated similar risk factors and receiver operating characteristic curves. CONCLUSION: We conclude that a focused rotavirus vaccination policy using readily identifiable potential high-risk groups would be unlikely to prevent most infant hospitalizations associated with rotavirus infection. However, the safety of rotavirus vaccine in low birth weight and premature infants must be established, because these children appear to be at greater risk for hospitalization with viral GE and rotavirus.

Original languageEnglish (US)
JournalPediatrics
Volume103
Issue number1
StatePublished - Jan 1 1999
Externally publishedYes

Fingerprint

Gastroenteritis
Hospitalization
Rotavirus
Rotavirus Vaccines
Rotavirus Infections
ROC Curve
Mothers
Birth Certificates
Illegitimacy
Very Low Birth Weight Infant
Maternal Age
Medicaid
Low Birth Weight Infant
Insurance
Birth Weight
Premature Infants
Case-Control Studies
Vaccination
Smoking
Parturition

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Perinatal risk factors for infant hospitalization with viral gastroenteritis. / Newman, R. D.; Grupp-Phelan, J.; Shay, D. K.; Davis, Robert.

In: Pediatrics, Vol. 103, No. 1, 01.01.1999.

Research output: Contribution to journalArticle

Newman, RD, Grupp-Phelan, J, Shay, DK & Davis, R 1999, 'Perinatal risk factors for infant hospitalization with viral gastroenteritis.', Pediatrics, vol. 103, no. 1.
Newman, R. D. ; Grupp-Phelan, J. ; Shay, D. K. ; Davis, Robert. / Perinatal risk factors for infant hospitalization with viral gastroenteritis. In: Pediatrics. 1999 ; Vol. 103, No. 1.
@article{ceaac5da13b6473cb59d2fc2b45d1421,
title = "Perinatal risk factors for infant hospitalization with viral gastroenteritis.",
abstract = "CONTEXT: A tetravalent vaccine against rotavirus, the most commonly identified etiologic agent of viral gastroenteritis (GE), has recently been licensed for use in the United States. OBJECTIVE: To evaluate whether specific groups of infants might be at sufficiently high risk to warrant a focused rotavirus vaccine policy, we investigated perinatal risk factors for hospitalization with viral GE and rotavirus in the first year of life. DESIGN: Population-based, case-control study. SETTING: Washington State linked birth certificate and hospital discharge abstracts from 1987 through 1995. PATIENTS: Infants, 1 through 11 months of age, hospitalized for viral GE (N = 1606) were patients in this study. Control subjects were 8084 nonhospitalized infants, frequency-matched to patients on year of birth. PRIMARY OUTCOME MEASURE: Maternal and infant characteristics associated with infant hospitalization for viral GE. RESULTS: We found a significant association between birth weight and the risk for hospitalization. Very low birth weight infants (<1500 g) were at the highest risk (odds ratio [OR] 2.6; 95{\%} confidence interval [CI]: 1.6,4.1);, low birth weight infants (1500-2499 g), at intermediate risk (OR 1.6; 95{\%} CI: 1.3,2.1); and large infants (>4000 g), at reduced risk (OR 0.8; 95{\%} CI: 0.6,0.9). Other characteristics associated with GE hospitalization were male gender (OR 1.4; 95{\%} CI: 1.3,1.6); maternal smoking (OR 1.2; 95{\%} CI: 1.1,1. 4); unmarried mother (OR 1.2; 95{\%} CI: 1.1,1.4); Medicaid insurance (OR 1.4; 95{\%} CI: 1.3,1.7); and maternal age <20 years (OR 1.2; 95{\%} CI: 1.0,1.5). Infants born October through December were at decreased risk for hospitalization (OR 0.8; 95{\%} CI: 0.7,0.9), as were infants born to Asian mothers (OR 0.5; 95{\%} CI: 0.3,0.7), and infants born to mothers >34 years of age (OR 0.7; 95{\%} CI: 0.6,0.9). Using these factors, the area under a receiver operating characteristic curve was 0.63. Therefore, to achieve a sensitivity of 90{\%} in identifying high-risk infants, specificity would fall to 10{\%}. Subanalyses of children admitted for viral GE during the peak of the Northwest rotavirus season (January to March) and children with confirmed rotavirus infection demonstrated similar risk factors and receiver operating characteristic curves. CONCLUSION: We conclude that a focused rotavirus vaccination policy using readily identifiable potential high-risk groups would be unlikely to prevent most infant hospitalizations associated with rotavirus infection. However, the safety of rotavirus vaccine in low birth weight and premature infants must be established, because these children appear to be at greater risk for hospitalization with viral GE and rotavirus.",
author = "Newman, {R. D.} and J. Grupp-Phelan and Shay, {D. K.} and Robert Davis",
year = "1999",
month = "1",
day = "1",
language = "English (US)",
volume = "103",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "1",

}

TY - JOUR

T1 - Perinatal risk factors for infant hospitalization with viral gastroenteritis.

AU - Newman, R. D.

AU - Grupp-Phelan, J.

AU - Shay, D. K.

AU - Davis, Robert

PY - 1999/1/1

Y1 - 1999/1/1

N2 - CONTEXT: A tetravalent vaccine against rotavirus, the most commonly identified etiologic agent of viral gastroenteritis (GE), has recently been licensed for use in the United States. OBJECTIVE: To evaluate whether specific groups of infants might be at sufficiently high risk to warrant a focused rotavirus vaccine policy, we investigated perinatal risk factors for hospitalization with viral GE and rotavirus in the first year of life. DESIGN: Population-based, case-control study. SETTING: Washington State linked birth certificate and hospital discharge abstracts from 1987 through 1995. PATIENTS: Infants, 1 through 11 months of age, hospitalized for viral GE (N = 1606) were patients in this study. Control subjects were 8084 nonhospitalized infants, frequency-matched to patients on year of birth. PRIMARY OUTCOME MEASURE: Maternal and infant characteristics associated with infant hospitalization for viral GE. RESULTS: We found a significant association between birth weight and the risk for hospitalization. Very low birth weight infants (<1500 g) were at the highest risk (odds ratio [OR] 2.6; 95% confidence interval [CI]: 1.6,4.1);, low birth weight infants (1500-2499 g), at intermediate risk (OR 1.6; 95% CI: 1.3,2.1); and large infants (>4000 g), at reduced risk (OR 0.8; 95% CI: 0.6,0.9). Other characteristics associated with GE hospitalization were male gender (OR 1.4; 95% CI: 1.3,1.6); maternal smoking (OR 1.2; 95% CI: 1.1,1. 4); unmarried mother (OR 1.2; 95% CI: 1.1,1.4); Medicaid insurance (OR 1.4; 95% CI: 1.3,1.7); and maternal age <20 years (OR 1.2; 95% CI: 1.0,1.5). Infants born October through December were at decreased risk for hospitalization (OR 0.8; 95% CI: 0.7,0.9), as were infants born to Asian mothers (OR 0.5; 95% CI: 0.3,0.7), and infants born to mothers >34 years of age (OR 0.7; 95% CI: 0.6,0.9). Using these factors, the area under a receiver operating characteristic curve was 0.63. Therefore, to achieve a sensitivity of 90% in identifying high-risk infants, specificity would fall to 10%. Subanalyses of children admitted for viral GE during the peak of the Northwest rotavirus season (January to March) and children with confirmed rotavirus infection demonstrated similar risk factors and receiver operating characteristic curves. CONCLUSION: We conclude that a focused rotavirus vaccination policy using readily identifiable potential high-risk groups would be unlikely to prevent most infant hospitalizations associated with rotavirus infection. However, the safety of rotavirus vaccine in low birth weight and premature infants must be established, because these children appear to be at greater risk for hospitalization with viral GE and rotavirus.

AB - CONTEXT: A tetravalent vaccine against rotavirus, the most commonly identified etiologic agent of viral gastroenteritis (GE), has recently been licensed for use in the United States. OBJECTIVE: To evaluate whether specific groups of infants might be at sufficiently high risk to warrant a focused rotavirus vaccine policy, we investigated perinatal risk factors for hospitalization with viral GE and rotavirus in the first year of life. DESIGN: Population-based, case-control study. SETTING: Washington State linked birth certificate and hospital discharge abstracts from 1987 through 1995. PATIENTS: Infants, 1 through 11 months of age, hospitalized for viral GE (N = 1606) were patients in this study. Control subjects were 8084 nonhospitalized infants, frequency-matched to patients on year of birth. PRIMARY OUTCOME MEASURE: Maternal and infant characteristics associated with infant hospitalization for viral GE. RESULTS: We found a significant association between birth weight and the risk for hospitalization. Very low birth weight infants (<1500 g) were at the highest risk (odds ratio [OR] 2.6; 95% confidence interval [CI]: 1.6,4.1);, low birth weight infants (1500-2499 g), at intermediate risk (OR 1.6; 95% CI: 1.3,2.1); and large infants (>4000 g), at reduced risk (OR 0.8; 95% CI: 0.6,0.9). Other characteristics associated with GE hospitalization were male gender (OR 1.4; 95% CI: 1.3,1.6); maternal smoking (OR 1.2; 95% CI: 1.1,1. 4); unmarried mother (OR 1.2; 95% CI: 1.1,1.4); Medicaid insurance (OR 1.4; 95% CI: 1.3,1.7); and maternal age <20 years (OR 1.2; 95% CI: 1.0,1.5). Infants born October through December were at decreased risk for hospitalization (OR 0.8; 95% CI: 0.7,0.9), as were infants born to Asian mothers (OR 0.5; 95% CI: 0.3,0.7), and infants born to mothers >34 years of age (OR 0.7; 95% CI: 0.6,0.9). Using these factors, the area under a receiver operating characteristic curve was 0.63. Therefore, to achieve a sensitivity of 90% in identifying high-risk infants, specificity would fall to 10%. Subanalyses of children admitted for viral GE during the peak of the Northwest rotavirus season (January to March) and children with confirmed rotavirus infection demonstrated similar risk factors and receiver operating characteristic curves. CONCLUSION: We conclude that a focused rotavirus vaccination policy using readily identifiable potential high-risk groups would be unlikely to prevent most infant hospitalizations associated with rotavirus infection. However, the safety of rotavirus vaccine in low birth weight and premature infants must be established, because these children appear to be at greater risk for hospitalization with viral GE and rotavirus.

UR - http://www.scopus.com/inward/record.url?scp=0032622443&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032622443&partnerID=8YFLogxK

M3 - Article

C2 - 9917483

AN - SCOPUS:0032622443

VL - 103

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 1

ER -