BackgroundThe improvement in survival of preterm infants is accompanied by an increase in neonatal intensive care unit (NICU) admissions. Prolonged length of stay in the NICU (LOS-NICU) increases the incidence of neonatal complications and even mortality and places a significant economic burden on families and strain on healthcare systems. This review aims to identify risk factors influencing LOS-NICU of newborns and to provide a basis for interventions to shorten LOS-NICU and avoid prolonged LOS-NICU.MethodsA systematic literature search was conducted in PubMed, Web of Science, Embase, and Cochrane library for studies that were published in English from January 1994 to October 2022. The PRISMA guidelines were followed in all phases of this systematic review. The Quality in Prognostic Studies (QUIPS) tool was used to assess methodological quality.ResultsTwenty-three studies were included, 5 of which were of high quality and 18 of moderate quality, with no low-quality literature. The studies reported 58 possible risk factors in six broad categories (inherent factors; antenatal treatment and maternal factors; diseases and adverse conditions of the newborn; treatment of the newborn; clinical scores and laboratory indicators; organizational factors).ConclusionsWe identified several of the most critical risk factors affecting LOS-NICU, including birth weight, gestational age, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. As only a few high-quality studies are available at present, well-designed and more extensive prospective studies investigating the risk factors affecting LOS-NICU are still needed in the future.

Background Breastfeeding has been recognized as the golden standard, but the breastfeeding rates of preterm infants remain low globally. Due to the lack of sound theoretical framework and the attention to maternal needs in breastfeeding, the overall evidence and effectiveness of intervention is limited. This study aimed to explore Chinese preterm mothers’ demands on breastfeeding using the Behaviour Change Wheel to provide insight into the future design of breastfeeding behavior-enhancing intervention. Method A qualitative descriptive design was conducted in Wuhan in 2022. Based on purposeful sampling, 14 preterm mothers were recruited from a NICU in a Grade Ⅲ Class A hospital in Wuhan, China. Face-to-face semi-structured interviews were conducted to collect data using the interview guide developed by the Theoretical Domains Framework. Theoretical Thematic Analysis was used to review the data in 6 steps to identify themes. Results Five major themes emerged: (1) capability: infants’ cues reading and abnormalities identification, coping knowledge accumulation, and skills training; (2) physical opportunity: cleanliness and peace in the home, privacy and breastfeeding aids in public places; (3) social opportunity: family co-parenting, peer support, authoritative advocacy; (4) reflective motivation: health outcome information; (5) automatic motivation: maternal-infant bonding, free of aversive stimulus. Conclusion Preterm mothers’ demands for breastfeeding were diverse including capability improvement, physical and social opportunities acquirement, as well as increase in reflective and automatic motivation. People, resources and environments associated with the demands should be engaged to enhance capability, create opportunities, and promote motivation. Future studies are needed to design effective interventions according to mothers’ specific demands.