Hospital admissions in infants with Down syndrome: a record-linked population-based cohort study in Wales.
R A Esperanza, A Evans, D Tucker and 2 others
PMID 34859911WHAT IT FOUND
80.3% of infants with Down syndrome were admitted to hospital in their first year, compared with 32.9% without.
The middle time to admission was 6 days, compared with 45 days for infants without it. Respiratory illness and congenital anomalies were common causes.
Key findings
01Of 356 infants with Down syndrome, 286 (80.3%) were admitted at least once during their first year of life, compared with 32.9% of infants without Down syndrome.
02The first admission happened at a median of 6 days (IQR 3, 72) and lasted a median of 4 days (IQR 1, 15), compared with 45 days (IQR 6, 166) and 1 day (IQR 0, 3) in infants without Down syndrome.
03Infants with Down syndrome and another congenital anomaly identified from admission data had a median of four admissions (IQR 3, 6) and a median total of 21 days in hospital (IQR 11, 47) in the first year, compared with a median total of 4 days (IQR 2, 11) for infants without Down syndrome and another congenital anomaly.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is an observational record-linkage study, not a trial, so it can describe hospital admission patterns but cannot show that any treatment caused or prevented admissions. The number of infants with Down syndrome was small relative to the whole cohort, and only 286 had at least one admission, which limits precision and subgroup analysis. Infants without Down syndrome were excluded if covariate data were missing, affecting 8444 (2.5%) of that group, so the analysed cohort may not include every infant. Admission causes relied on the first available hospital diagnosis code, and 12.4% of admissions had no diagnosis code, so cause patterns are uncertain. Down syndrome itself was often coded as the primary cause of admission, which may not reflect the actual reason the child needed hospital care. Other congenital anomalies were only counted if they were the primary reason for an admission in the first year, so less severe anomalies may be missed. Birth dates were recorded as the Monday of the birth week, which adds some inaccuracy when measuring time to first admission. The study cannot tell whether intellectual disability or family circumstances influenced admission decisions.
Declared interests
No conflicts of interest were declared. The research was supported by DECIPHer and CIPHER. CIPHER was funded by Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute for Health Research, the National Institute for Social Care and Health Research, and the Wellcome Trust. The Wales Electronic Cohort for Children was supported by a Translational Health Research Platform Award from the National Institute for Social Care and Health Research.
The easy way to misread this
Do not read the 80.3% admission rate as evidence that hospital admission is inevitable or caused by any particular care. This was a record-linked observational cohort, and it counted admissions without testing whether a treatment prevented them.