Risk Factors for hospital admission and length of stay for children with and without congenital anomalies: A EUROlinkCAT cohort study

Joanne Given; Ester Garne; Joan K. Morris; Silvia  Baldacci; Elisa Ballardini,; Mika Gissler; Francesca Gorini; Sonja Kiuru-Kuhlefelt; Stine Kjaer Urhoj; Marco Manfrini; Joachim  Tan; Maria Loane

doi:10.1136/bmjpo-2025-003586

Risk Factors for hospital admission and length of stay for children with and without congenital anomalies: A EUROlinkCAT cohort study

Joanne Given
, Ester Garne
, Joan K. Morris
, Silvia Baldacci
, Elisa Ballardini,
, Mika Gissler
, Francesca Gorini
, Sonja Kiuru-Kuhlefelt
, Stine Kjaer Urhoj
, Marco Manfrini
, Joachim Tan
, Maria Loane

University of Ferrara

Research output: Contribution to journal › Article › peer-review

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Abstract

Objective To evaluate risk factors for hospital admission and length of stay (LOS) among children with and without congenital anomalies (CAs).

Design A population-based linkage cohort study including 50 353 children with major CAs and 1 259 925 children without CAs from four EUROCAT registry areas in three countries. Data on children born 1995–2014 were linked to hospital discharge databases 1995–2015. HRs and incidence rate ratios estimated risk of admission and LOS for children aged <1 and 1–4 years by birth cohort, gestational age, sex, maternal age, multiple births and maternal education. Estimates were pooled using random effects meta-analysis.

Results In children <1 year, twins/triplets with CAs were 34% more likely to be admitted and had over two times the LOS compared with singletons, while twins/triplets without CAs were over two and a half times as likely to be admitted and had six times longer stays. Despite this, a higher proportion of twins/triplets with CAs were admitted compared to those without CAs (91% vs 65%) and had longer LOS (20 days vs 10). Smaller increases in risk of admission or LOS were found in boys, young mothers and low maternal education. Preterm birth was a major risk factor for admission and LOS.

Conclusions While the impact of risk factors on hospital admission and LOS was generally greater in children without CAs, a higher proportion of children with CAs were admitted and had longer stays. These findings have implications for health care planning and for counselling parents regarding their child's future healthcare needs.

Original language	English
Article number	e003586
Pages (from-to)	1-11
Number of pages	11
Journal	BMJ Paediatrics Open
Volume	9
Issue number	1
Early online date	14 Aug 2025
DOIs	https://doi.org/10.1136/bmjpo-2025-003586
Publication status	Published (in print/issue) - 14 Aug 2025

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

Data Availability Statement

The data that support the findings of this study are available, but restrictions apply to the availability of these data, which were used under license for the current study and so are not publicly available. Data are, however, available from the authors after the permission of the participating registries of congenital anomalies.

Funding

This work was supported by the European Union\u2019s Horizon 2020 Research and Innovation programme under grant agreement number 733001, from 1 January 2017 to 31 May 2022. The views presented here are those of the authors only, and the European Commission is not responsible for any use that may be made of the information presented here.

Funder number
733001

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Cohort Studies
Congenital Anomalies
Registries
Risk factors
length of stay
Episode of care
Data Collection
Child Health
Epidemiology
Health services research
Information Technology

Access to Document

10.1136/bmjpo-2025-003586

e003586.fullFinal published version, 1.7 MBLicence: CC BY-NC

Cite this

Given, J., Garne, E., Morris, J. K., Baldacci, S., Ballardini, E., Gissler, M., Gorini, F., Kiuru-Kuhlefelt, S., Kjaer Urhoj, S., Manfrini, M., Tan, J., & Loane, M. (2025). Risk Factors for hospital admission and length of stay for children with and without congenital anomalies: A EUROlinkCAT cohort study. BMJ Paediatrics Open, 9(1), 1-11. Article e003586. https://doi.org/10.1136/bmjpo-2025-003586

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title = "Risk Factors for hospital admission and length of stay for children with and without congenital anomalies: A EUROlinkCAT cohort study",

abstract = "Objective To evaluate risk factors for hospital admission and length of stay (LOS) among children with and without congenital anomalies (CAs).Design A population-based linkage cohort study including 50 353 children with major CAs and 1 259 925 children without CAs from four EUROCAT registry areas in three countries. Data on children born 1995–2014 were linked to hospital discharge databases 1995–2015. HRs and incidence rate ratios estimated risk of admission and LOS for children aged <1 and 1–4 years by birth cohort, gestational age, sex, maternal age, multiple births and maternal education. Estimates were pooled using random effects meta-analysis.Results In children <1 year, twins/triplets with CAs were 34\% more likely to be admitted and had over two times the LOS compared with singletons, while twins/triplets without CAs were over two and a half times as likely to be admitted and had six times longer stays. Despite this, a higher proportion of twins/triplets with CAs were admitted compared to those without CAs (91\% vs 65\%) and had longer LOS (20 days vs 10). Smaller increases in risk of admission or LOS were found in boys, young mothers and low maternal education. Preterm birth was a major risk factor for admission and LOS.Conclusions While the impact of risk factors on hospital admission and LOS was generally greater in children without CAs, a higher proportion of children with CAs were admitted and had longer stays. These findings have implications for health care planning and for counselling parents regarding their child's future healthcare needs. ",

keywords = "Cohort Studies, Congenital Anomalies, Registries, Risk factors, length of stay, Episode of care, Data Collection, Child Health, Epidemiology, Health services research, Information Technology",

author = "Joanne Given and Ester Garne and Morris, \{Joan K.\} and Silvia Baldacci and Elisa Ballardini, and Mika Gissler and Francesca Gorini and Sonja Kiuru-Kuhlefelt and \{Kjaer Urhoj\}, Stine and Marco Manfrini and Joachim Tan and Maria Loane",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.",

year = "2025",

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Given, J, Garne, E, Morris, JK, Baldacci, S, Ballardini, E, Gissler, M, Gorini, F, Kiuru-Kuhlefelt, S, Kjaer Urhoj, S, Manfrini, M, Tan, J & Loane, M 2025, 'Risk Factors for hospital admission and length of stay for children with and without congenital anomalies: A EUROlinkCAT cohort study', BMJ Paediatrics Open, vol. 9, no. 1, e003586, pp. 1-11. https://doi.org/10.1136/bmjpo-2025-003586

TY - JOUR

T1 - Risk Factors for hospital admission and length of stay for children with and without congenital anomalies: A EUROlinkCAT cohort study

AU - Given, Joanne

AU - Garne, Ester

AU - Morris, Joan K.

AU - Baldacci, Silvia

AU - Ballardini,, Elisa

AU - Gissler, Mika

AU - Gorini, Francesca

AU - Kiuru-Kuhlefelt, Sonja

AU - Kjaer Urhoj, Stine

AU - Manfrini, Marco

AU - Tan, Joachim

AU - Loane, Maria

N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

PY - 2025/8/14

Y1 - 2025/8/14

N2 - Objective To evaluate risk factors for hospital admission and length of stay (LOS) among children with and without congenital anomalies (CAs).Design A population-based linkage cohort study including 50 353 children with major CAs and 1 259 925 children without CAs from four EUROCAT registry areas in three countries. Data on children born 1995–2014 were linked to hospital discharge databases 1995–2015. HRs and incidence rate ratios estimated risk of admission and LOS for children aged <1 and 1–4 years by birth cohort, gestational age, sex, maternal age, multiple births and maternal education. Estimates were pooled using random effects meta-analysis.Results In children <1 year, twins/triplets with CAs were 34% more likely to be admitted and had over two times the LOS compared with singletons, while twins/triplets without CAs were over two and a half times as likely to be admitted and had six times longer stays. Despite this, a higher proportion of twins/triplets with CAs were admitted compared to those without CAs (91% vs 65%) and had longer LOS (20 days vs 10). Smaller increases in risk of admission or LOS were found in boys, young mothers and low maternal education. Preterm birth was a major risk factor for admission and LOS.Conclusions While the impact of risk factors on hospital admission and LOS was generally greater in children without CAs, a higher proportion of children with CAs were admitted and had longer stays. These findings have implications for health care planning and for counselling parents regarding their child's future healthcare needs.

AB - Objective To evaluate risk factors for hospital admission and length of stay (LOS) among children with and without congenital anomalies (CAs).Design A population-based linkage cohort study including 50 353 children with major CAs and 1 259 925 children without CAs from four EUROCAT registry areas in three countries. Data on children born 1995–2014 were linked to hospital discharge databases 1995–2015. HRs and incidence rate ratios estimated risk of admission and LOS for children aged <1 and 1–4 years by birth cohort, gestational age, sex, maternal age, multiple births and maternal education. Estimates were pooled using random effects meta-analysis.Results In children <1 year, twins/triplets with CAs were 34% more likely to be admitted and had over two times the LOS compared with singletons, while twins/triplets without CAs were over two and a half times as likely to be admitted and had six times longer stays. Despite this, a higher proportion of twins/triplets with CAs were admitted compared to those without CAs (91% vs 65%) and had longer LOS (20 days vs 10). Smaller increases in risk of admission or LOS were found in boys, young mothers and low maternal education. Preterm birth was a major risk factor for admission and LOS.Conclusions While the impact of risk factors on hospital admission and LOS was generally greater in children without CAs, a higher proportion of children with CAs were admitted and had longer stays. These findings have implications for health care planning and for counselling parents regarding their child's future healthcare needs.

KW - Cohort Studies

KW - Congenital Anomalies

KW - Registries

KW - Risk factors

KW - length of stay

KW - Episode of care

KW - Data Collection

KW - Child Health

KW - Epidemiology

KW - Health services research

KW - Information Technology

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DO - 10.1136/bmjpo-2025-003586

M3 - Article

C2 - 40813139

SN - 2399-9772

VL - 9

SP - 1

EP - 11

JO - BMJ Paediatrics Open

JF - BMJ Paediatrics Open

IS - 1

M1 - e003586

ER -

Risk Factors for hospital admission and length of stay for children with and without congenital anomalies: A EUROlinkCAT cohort study

Abstract

Bibliographical note

Data Availability Statement

Funding

UN SDGs

Keywords

Access to Document

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