(186) Common Diagnoses, Procedures and Medications in The First Year of An Infant's Life

Publication Number: 1231

Background: Health insurance claims data contain rich information on common diagnoses, procedures and medications (DPMs) in the first year of life.

Objectives: To determine timing of common DPMs in the first year of life.

Methods: We utilized Optum's Dynamic Assessment of Pregnancies and Infants (DAPI), a pregnancy database within Optum’s health insurance claims data. We identified diagnoses using ICD-10 codes, procedures using CPT® and HCPCS codes, and medications by generic names. DPM frequencies were tabulated for days 1-10 (~1-week visit), 11-25 (~2 weeks), 26-45 (~1 month), 46-84 (~2-3 months), 85-134 (>3-4 months), 135-197 (>4-6 months), 198-285 (>6-9 months) and 286-388 (>9-12 months). Observed distributions of provider visits guided these ranges. For example, D286-388, corresponding to the >9-12 month visit, had a distribution of visits that peaked on D369.

Results: There were 645,827 infants with data on D1-10 and 350,839 on D286-388. Immunization encounters and screenings for other diseases were among the top 25 diagnosis codes on D1-388. Symptoms and signs concerning food/fluid intake were among the top 25 diagnoses on D1-285. Neonatal jaundice, respiratory distress and other perinatal respiratory conditions were common on D1-45. Gastro-esophageal reflux disease became more common after D26 and acute infections (respiratory, bronchiolitis, otitis media), fever and coughs after D45. In terms of major congenital malformations (MCMs), skin MCMs were among the top 25 diagnoses on D1-10; tongue/mouth/pharynx MCMs on D1-29; cardiac septa MCMs on D11-45; and head/face/spine/chest MCMs on D46-84. In terms of procedures, audiometry, circumcisions and total bilirubin were common on D1-10, capillary blood collection (e.g., heel sticks) and metabolic screening on D11-25, and vaccines thereafter (e.g., rotavirus, diphtheria/tetanus/pertussis/hepatitis B/inactivated poliovirus, haemophilus influenzae B and pneumococcal conjugate vaccine). Among the 25 most dispensed medications on D1-388 were antibiotics (e.g., erythromycin, mupirocin, amoxicillin, polymyxin B sulfate/trimethoprim, cephalexin); antifungal nystatin; glucocorticoids hydrocortisone and triamcinolone acetonide; and antihistamine/antacids ranitidine and famotidine. Proton pump inhibitors lansoprazole, omeprazole and esomeprazole magnesium became more common after D11; β-2 adrenergic agent albuterol sulfate after D26; antiviral agent oseltamivir phosphate after D46; and glucocorticoid prednisolone after D85.

Conclusions: The timing of common DPMs in the first year of life may inform the design of studies on infant health. For example, studies of perinatal medications and risk of infant acute infection may require >2 months of infant follow-up within the database.