Variations in length of stay among survived very preterm infants admitted to Chinese neonatal intensive care units

Abstract

Background This study aimed to describe length of stay (LOS) to discharge and site variations among very preterm infants (VPIs) admitted to 57 Chinese neonatal intensive care units (NICUs) and to investigate factors associated with LOS for VPIs. Methods This retrospective multicenter cohort study enrolled all infants < 32 weeks’ gestation and admitted to 57 NICUs which had participated in the Chinese Neonatal Network, within 7 days after birth in 2019. Exclusion criteria included major congenital anomalies, NICU deaths, discharge against medical advice, transfer to non-participating hospitals, and missing discharge date. Two multivariable linear models were used to estimate the association of infant characteristics and LOS. Results A total of 6580 infants were included in our study. The overall median LOS was 46 days [interquartile range (IQR): 35–60], and the median corrected gestational age at discharge was 36 weeks (IQR: 35–38). LOS and corrected gestational age at discharge increased with decreasing gestational age. The median corrected gestational age at discharge for infants at 24 weeks, 25 weeks, 26 weeks, 27–28 weeks, and 29–31 weeks were 41 weeks, 39 weeks, 38 weeks, 37 weeks and 36 weeks, respectively. Significant site variation of LOS was identified with observed median LOS from 33 to 71 days in different hospitals. Conclusions The study provided concurrent estimates of LOS for VPIs which survived in Chinese NICUs that could be used as references for medical staff and parents. Large variation of LOS independent of infant characteristics existed, indicating variation of care practices requiring further investigation and quality improvement.

Risk factors for length of NICU stay of newborns: A systematic review

“…Of these studies, four were prospective studies ( 24 – 27 ) and the remaining 19 studies were retrospective ( 1 , 9 , 18 , 28 – 43 ), of which 14 were multicenter studies ( 9 , 24 , 25 , 27 – 29 , 31 , 33 – 35 , 37 – 39 , 42 ) and 9 were single-center studies ( 1 , 18 , 26 , 30 , 32 , 36 , 40 , 41 , 43 ). The sample size ranged from 191 to 7,60,037.…”

“…The studies investigated a range of newborns with different gestational ages and different birth weights, of which seven studies were conducted with preterm infants as respondents ( 1 , 9 , 24 , 33 , 36 , 38 , 41 ); four studies were conducted in low birth weight infants as respondents ( 25 , 27 , 37 , 39 ); two studies included only newborns who were recipients of intravenous (IV) fluids for at least 48 h, based on the purpose of the study, in order to enroll infants most likely to have serial serum creatinine (SCR) and urine output (UOP) measurements ( 29 , 35 ); two studies made different requirements for gestational age or birth weight ( 34 , 42 ); and the other eight studies included all eligible newborns without other requirements for gestational age or birth weight ( 18 , 26 , 28 , 30 – 32 , 40 , 43 ).…”

“…Exclusion criteria mainly included the following: death during NICU stay or prior to admission ( 1 , 9 , 18 , 24 , 26 , 27 , 29 – 31 , 33 – 35 , 37 , 39 – 42 ); lethal chromosomal abnormalities or severe congenital malformations ( 1 , 9 , 18 , 26 , 27 , 29 , 31 , 33 – 36 , 38 , 39 ); missing information on LOS-NICU or other key information ( 25 , 30 , 32 , 33 , 36 , 39 ); transfer to another NICU or long-term care facility ( 1 , 9 , 24 , 27 , 30 , 31 , 33 , 36 , 39 , 41 , 42 ); and discharge against medical advice ( 1 , 31 , 33 ). In addition, exclusions included surgery ( 27 , 29 , 34 , 35 ); readmission after initial discharge ( 24 , 32 , 34 ); LOS-NICU less than 24 h ( 32 ) or more than 1 year ( 9 ); and admission 24 h ( 24 ), 7 days ( 35 ), or 14 days ( 29 ) after birth and admission for convalescent, step-down care or preterminal comfort care ( 18 , 28 , 31 ).…”

“…There were few issues related to study participation, as in most studies, information was obtained from medical records and electronic databases, which would possibly introduce a low risk of bias. Study attrition due to newborns being transferred out of the hospital or study coverage area was a potential issue, with only one of the studies continuing follow-up of transferred newborns until they were discharged ( 33 ). With regard to the definition of LOS-NICU, four studies were classified.…”

“…All 23 studies accounted for some form of inherent factor or diseases and adverse conditions of the newborn. The risk factors that were most widely studied and most consistently associated with LOS-NICU were the following: birth weight (60.9%,14/23) ( 9 , 18 , 24 – 27 , 30 , 32 , 34 , 36 , 37 , 40 – 42 ); gestational age (43.5%,10/23) ( 18 , 24 – 26 , 30 – 33 , 40 , 41 ); sepsis (30.4%,7/23) ( 9 , 24 , 30 , 31 , 33 , 37 , 41 ); necrotizing enterocolitis (NEC) (21.7%,5/23) ( 9 , 24 , 33 , 36 , 37 ); bronchopulmonary dysplasia (BPD) (21.7%,5/23) ( 9 , 24 , 33 , 36 , 37 ); and retinopathy of prematurity (ROP) (17.2%,4/23) ( 9 , 30 , 33 , 36 ). Although most studies used congenital anomaly as an exclusion criterion, four studies suggested that congenital anomaly may be a risk factor for LOS-NICU ( 24 , 28 , 30 , 37 ).…”