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Soldateli B, Silveira RC, Procianoy RS, Edwards EM, Belfort MB. Association between type of feeding at hospital discharge and nutritional status of Brazilian very preterm infants: a multicenter study. J Pediatr (Rio J) 2024:S0021-7557(24)00086-X. [PMID: 39025129 DOI: 10.1016/j.jped.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVES To examine trends over time in diet and size of very preterm infants, and associations of diet with size at hospital discharge/transfer. METHODS The authors studied 4062 surviving very preterm infants born < 32 weeks' gestational age and < 1500 g between January 2012 and December 2020 from 12 Brazilian Neonatal Intensive Care Units. Diet type at discharge/transfer was classified as exclusive human milk, exclusive formula, or mixed. Outcomes were weight and head circumference at hospital discharge and the change in each from birth to discharge. The authors used linear regression to estimate adjusted associations of diet type with infant size, overall, and stratified by fetal growth category (small vs. appropriate for gestational age). The authors also examined trends in diet and infant size at discharge over the years. RESULTS Infants' mean gestational age at birth was 29.3 weeks, and the mean birth weight was 1136 g. Diet at discharge/transfer was exclusive human milk for 22 %, mixed for 62 %, and exclusive formula for 16 %. Infant size in weight and head circumference were substantially below the growth chart reference for all diets. Infants fed human milk and mixed diets were lighter and had smaller heads at discharge/transfer than infants fed formula only (weight z: -2.0, -1.8, and -1.5; head z: -1.3, -1.2 and -1.1 for exclusive human milk, mixed and exclusive formula respectively). CONCLUSION Results suggest high human milk use but gaps in nutrient delivery among hospitalized Brazilian very preterm infants, with little evidence of improvement over time.
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Affiliation(s)
- Betina Soldateli
- Faculdade de Medicina, Departamento de Nutrição, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Serviço de Nutrição e Dietética, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
| | - Rita C Silveira
- Faculdade de Medicina, Departamento de Pediatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Neonatologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Renato S Procianoy
- Faculdade de Medicina, Departamento de Pediatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Neonatologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, VT, USA; College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, USA; The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Mandy B Belfort
- Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
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Edwards EM, Ehret DEY, Horbar JD. Potentially Better Practices for Follow Through in Neonatal Intensive Care Units. Pediatrics 2024; 154:e2023065530. [PMID: 38872618 DOI: 10.1542/peds.2023-065530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE To ascertain how NICU teams are undertaking action to follow through, involving teams, families, and communities as partners to address health-related social needs of infants and families. METHODS Nineteen potentially better practices (PBPs) for follow through first published in 2020 were reported and analyzed as a sum, overall, and by safety-net hospital status, hospital ownership, and NICU type, among US NICUs that finalized Vermont Oxford Network data collection in 2023. RESULTS One hundred percent of 758 eligible hospitals completed the annual membership survey, of which 57.5% reported screening for social risks. Almost all NICUs offered social work, lactation support, and translation services, but only 16% included a lawyer or paralegal on the team. Overall, 90.2% helped families offset financial costs while their infants were in the hospital, either with direct services or vouchers. At discharge, 94.0% of NICUs connected families with appropriate community organizations and services, 52.9% provided telemedicine after discharge, and 11.7% conducted home visits. The median number of PBPs at each hospital was 10 (25th percentile: 8, 75th percentile: 12). The number of PBPs reported differed by hospital control or ownership and level of NICU care. There were no differences by safety-net hospital status. CONCLUSIONS Despite concerns about time and resources, a diverse set of US NICUs reported adopting potentially better practices for follow through. However, the marked variation among NICUs and the lower rates at for-profit and lower-level NICUs suggest there is substantial opportunity for improvement.
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Affiliation(s)
- Erika M Edwards
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, Vermont
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, Burlington, Vermont
| | - Danielle E Y Ehret
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, Vermont
| | - Jeffrey D Horbar
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, Vermont
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de Bijl-Marcus K, Benders MJNL, Dudink J, Ahaus K, Kahlmann M, Groenendaal F. Morbidity and trends in length of hospitalisation of very and extremely preterm infants born between 2008 and 2021 in the Netherlands: a cohort study. BMJ Open 2024; 14:e078842. [PMID: 38834326 PMCID: PMC11163635 DOI: 10.1136/bmjopen-2023-078842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/14/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVES This study investigated changes in the length of stay (LoS) at a level III/IV neonatal intensive care unit (NICU) and level II neonatology departments until discharge home for very preterm infants and identified factors influencing these trends. DESIGN Retrospective cohort study based on data recorded in the Netherlands Perinatal Registry between 2008 and 2021. SETTING A single level III/IV NICU and multiple level II neonatology departments in the Netherlands. PARTICIPANTS NICU-admitted infants (n=2646) with a gestational age (GA) <32 weeks. MAIN OUTCOME MEASURES LoS at the NICU and overall LoS until discharge home. RESULTS The results showed an increase of 5.1 days (95% CI 2.2 to 8, p<0.001) in overall LoS in period 3 after accounting for confounding variables. This increase was primarily driven by extended LoS at level II hospitals, while LoS at the NICU remained stable. The study also indicated a strong association between severe complications of preterm birth and LoS. Treatment of infants with a lower GA and more (severe) complications (such as severe retinopathy of prematurity) during the more recent periods may have increased LoS. CONCLUSION The findings of this study highlight the increasing overall LoS for very preterm infants. LoS of very preterm infants is presumably influenced by the occurrence of complications of preterm birth, which are more frequent in infants at a lower gestational age.
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Affiliation(s)
- Karen de Bijl-Marcus
- Department of Neonatology, Universitair Medisch Centrum Utrecht-Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Universitair Medisch Centrum Utrecht-Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Universitair Medisch Centrum Utrecht-Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Marijn Kahlmann
- Department of Neonatology, Universitair Medisch Centrum Utrecht-Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Universitair Medisch Centrum Utrecht-Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
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Kaempf JW, Wang L, Dunn M. The Triple Aim Quality Improvement Gold Standard Illustrated as Extremely Premature Infant Care. Am J Perinatol 2024; 41:e1172-e1182. [PMID: 36539206 DOI: 10.1055/a-2001-8844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The Triple Aim is widely regarded as the quality improvement gold standard that enhances population health, lowers costs, and betters individual care. There have been no large-scale, sustained demonstrations of such improvement in healthcare. Illustrating the Triple Aim using relevant extremely premature infant outcomes might highlight interwoven proficiency and efficiency complexities that impede sustained value progress. STUDY DESIGN Ten long-term collaborating neonatal intensive care units (NICU) in the Vermont Oxford Network calculated the Triple Aim in 230/7 to 276/7-week infants using three surrogate measures: (1) population health/x-axis-eight major morbidity rates as a composite, risk-adjusted metric; (2) cost/y-axis-total hospital length of stay; and (3) individual care/z-axis-mortality, then illustrated this relationship as a sphere within a three-dimensional cube. RESULTS Three thousand seven hundred six infants born between January 1, 2014 and December 31, 2019, with mean (standard deviation) gestational age of 25.7 (1.4) weeks and birth weight of 803 (208) grams were analyzed. Triple Aim three-axis cube positions varied inconsistently comparing NICUs. Each NICUs' sphere illustrated mixed x- and z-axis movement (clinical proficiency), and y-axis movement (cost efficiency). No NICU demonstrated the theoretically ideal Triple Aim improvement in all three axes. Backward movement in at least one axis occurred in eight NICUs. The whole-group Triple Aim sphere moved forward along the x-axis (better morbidities metric), but moved backward in the y-axis length of stay and z-axis mortality measurements. CONCLUSION Illustrating the Triple Aim gold standard as extreme prematurity outcomes reveals complexities inherent to simultaneous attempts at improving interwoven quality and cost outcomes. Lack of progress using relevant Triple Aim parameters from our well-established collaboration highlights the difficulties prioritizing competing outcomes, variable potentially-better-practice applications amongst NICUs, unmeasured biologic interactions, and obscured cultural-environmental contexts that all likely affect care. Triple Aim excellence, if even remotely possible, will necessitate scalable, evidence-based methodologies, pragmatism regarding inevitable trade-offs, and wise constrained-resource decisions. KEY POINTS · The Triple Aim gold standard is elusive. There is no demonstration of sustained, large-scale success in healthcare and our quality improvement network has previously published benchmark extreme prematuritymorbidity improvements.. · Extreme prematurity outcomes illustrated as the Triple Aim show uneven results in relevant surrogate parameters and Triple Aim achievement, if even possible, will necessitate evidence-based methodologies that are scalable.. · Pragmatism, inevitable trade-offs, and wise constrained-resource decisions are required for Triple Aim success..
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Affiliation(s)
- Joseph W Kaempf
- Providence St. Vincent Medical Center, Women and Children's Services, Medical Data and Research Center, Portland, Oregon
| | - Lian Wang
- Providence St. Vincent Medical Center, Women and Children's Services, Medical Data and Research Center, Portland, Oregon
| | - Michael Dunn
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Yeung T, Ahmed A, Wong J, Toye J, Abou Mehrem A, Mukerji A, Lapointe A, Ng E, Beltempo M, Pechlivanoglou P, Lee S, Shah PS. Variations in Site-Specific Costs for Infants Born Extremely Preterm in Canadian Neonatal Intensive Care Units. J Pediatr 2024; 266:113863. [PMID: 38096975 DOI: 10.1016/j.jpeds.2023.113863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/19/2023] [Accepted: 11/29/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE To quantify site-specific costs and their association with survival without major morbidity (SWMM) in Canada for neonates <28 weeks of gestation admitted to large tertiary neonatal intensive care units. METHODS We conducted a retrospective analysis of infants born at <28 weeks of gestation and admitted to Canadian Neonatal Network sites from 2010 through 2021. Sites that cared for at least 50 eligible infants by gestational age in weeks over the study period were included. Using a validated costing algorithm that assessed physician, nursing, respiratory therapy, diagnostic imaging, transfusions, procedural, medication, and certain indirect costs, we calculated site and resource-specific costs in 2017 Canadian dollars (CAD) and evaluated their relationship with SWMM. RESULTS Seven sites with 8180 (range 841-1605) eligible neonates with a mean (SD) gestation of 25.4 [1.3] weeks were included. Survival to discharge or transfer was 85.3% with a mean (SD) length of stay of 75 (46) days. The mean (SD) total and daily costs per neonate varied between $94 992 ($60 283) and $174 438 ($130 501) CAD and $1833 ($916) to $2307 ($1281) CAD, respectively. Between sites, there was no relationship between costs and SWMM. CONCLUSIONS There was marked variation in costs and SWMM between sites in Canada with universal health care. The lack of concordance between both outcomes and costs among sites may provide possibilities for outcomes improvement and cost containment.
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Affiliation(s)
- Telford Yeung
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Section of Neonatology, Windsor Regional Hospital Metropolitan Campus, Windsor, Ontario, Canada
| | - Asma Ahmed
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathan Wong
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jennifer Toye
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Ayman Abou Mehrem
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Amit Mukerji
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | - Eugene Ng
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Marc Beltempo
- Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Petros Pechlivanoglou
- Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Shoo Lee
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Mother-Infant Care Research Center, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada; Mother-Infant Care Research Center, Toronto, Ontario, Canada.
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Lapcharoensap W, Bennett M, Xu X, Lee HC, Profit J, Dukhovny D. Quality, outcome, and cost of care provided to very low birth weight infants in California. J Perinatol 2024; 44:224-230. [PMID: 37805592 DOI: 10.1038/s41372-023-01792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To examine association of costs with quality of care and patient outcome across hospitals in California. METHODS Retrospective study of very low birth weight (VLBW) births from 2014-2018 linking birth certificate, hospital discharge records and clinical data. Quality was measured using the Baby-MONITOR score. Clinical outcome was measured using survival without major morbidity (SWMM). Hierarchical generalized linear models, adjusting for clinical factors, were used to estimate risk-adjusted measures of costs, quality, and outcome for each hospital. Association between these measures was evaluated using Pearson correlation coefficient. RESULTS In total, 15,415 infants from 104 NICUs were included. Risk-adjusted Baby-MONITOR score, SWMM rate, and costs varied substantially. There was no correlation between risk-adjusted cost and Baby-MONITOR score (r = 0, p = 0.998). Correlation between risk-adjusted cost and SWMM rate was inverse and not significant (r = -0.07, p = 0.48). CONCLUSIONS With the metrics used, we found no correlation between cost, quality, and outcomes in the care of VLBW infants.
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Affiliation(s)
- Wannasiri Lapcharoensap
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, 97239, USA.
| | - Mihoko Bennett
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, 94305, USA
- California Perinatal Quality Care Collaborative, Stanford, CA, 94305, USA
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, CT, 06520, USA
| | - Henry C Lee
- California Perinatal Quality Care Collaborative, Stanford, CA, 94305, USA
- Division of Neonatology, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92093, USA
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, 94305, USA
- California Perinatal Quality Care Collaborative, Stanford, CA, 94305, USA
| | - Dmitry Dukhovny
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, 97239, USA
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Horbar JD, Greenberg LT, Buzas JS, Ehret DEY, Soll RF, Edwards EM. Trends in Mortality and Morbidities for Infants Born 24 to 28 Weeks in the US: 1997-2021. Pediatrics 2024; 153:e2023064153. [PMID: 38053449 DOI: 10.1542/peds.2023-064153] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Mortality and morbidity for very preterm infants in the United States decreased for years. The current study describes recent changes to assess whether the pace of improvement has changed. METHODS Vermont Oxford Network members contributed data on infants born at 24 to 28 weeks' gestation from 1997 to 2021. We modeled mortality, late-onset sepsis, necrotizing enterocolitis, chronic lung disease, severe intraventricular hemorrhage, severe retinopathy of prematurity, and death or morbidity by year of birth using segmented relative risk regression, reporting risk-adjusted annual percentage changes with 95% confidence intervals overall and by gestational age week. RESULTS Analyses of data for 447 396 infants at 888 hospitals identified 3 time point segments for mortality, late onset sepsis, chronic lung disease, severe intraventricular hemorrhage, severe retinopathy of prematurity, and death or morbidity, and 4 for necrotizing enterocolitis. Mortality decreased from 2005 to 2021, but more slowly since 2012. Late-onset sepsis decreased from 1997 to 2021, but more slowly since 2012. Severe retinopathy of prematurity decreased from 2002 to 2021, but more slowly since 2011. Necrotizing enterocolitis, severe intraventricular hemorrhage, and death or morbidity were stable since 2015. Chronic lung disease has increased since 2012. Trends by gestational age generally mirror those for the overall cohort. CONCLUSIONS Improvements in mortality and morbidity have slowed, stalled, or reversed in recent years. We propose a 3-part strategy to regain the pace of improvement: research; quality improvement; and follow through, practicing social as well as technical medicine to improve the health and well-being of infants and families.
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Affiliation(s)
- Jeffrey D Horbar
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner, Maryland College of Medicine, University of Vermont, Burlington, Vermont
| | - Lucy T Greenberg
- Vermont Oxford Network, Burlington, Vermont
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont
| | - Jeffrey S Buzas
- Vermont Oxford Network, Burlington, Vermont
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont
| | - Danielle E Y Ehret
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner, Maryland College of Medicine, University of Vermont, Burlington, Vermont
| | - Roger F Soll
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner, Maryland College of Medicine, University of Vermont, Burlington, Vermont
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner, Maryland College of Medicine, University of Vermont, Burlington, Vermont
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont
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Parker MG. Determining of the Right Amount of High-risk Neonatal Care. Med Care 2023; 61:727-728. [PMID: 37733415 DOI: 10.1097/mlr.0000000000001927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, UMass Chan Memorial Medical School, Worcester, MA
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Lockyear C, Coe K, Greenberg RG, Clark RH, Aleem S. Trends in morbidities of late preterm infants in the neonatal intensive care unit. J Perinatol 2023; 43:1379-1384. [PMID: 37393396 DOI: 10.1038/s41372-023-01705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/20/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To characterize demographics and trends in length of stay (LOS), morbidities, and mortality in late preterm infants. STUDY DESIGN Cohort study of infants born between 34 0/7 and 36 6/7 weeks gestation between 1999 and 2018 without major congenital anomalies at Pediatrix Medical Group neonatal intensive care units (NICUs). RESULTS 307,967 infants from 410 NICUs met inclusion criteria. The median (25th-75th percentile) LOS was 11 (8-16) days in the entire period. Postmenstrual age (PMA) at discharge increased during the cohort for all gestational ages (p < 0.001). There was a decrease in invasive ventilation, receipt of phototherapy, and reflux medications observed (p < 0.001). CONCLUSION In this large cohort, given 20 years of time for medical advancement, there was no significant improvement in the LOS of late preterm infants. All infants had an increased PMA at discharge, despite multiple practice changes that were observed.
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Affiliation(s)
| | - Kristi Coe
- Duke School of Nursing, Duke University, Durham, NC, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Reese H Clark
- Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL, USA
| | - Samia Aleem
- Department of Pediatrics, Duke University, Durham, NC, USA.
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Bernardo J, Keiser A, Aucott S, Yanek LR, Johnson CT, Donohue P. Early Readmission following NICU Discharges among a National Sample: Associated Factors and Spending. Am J Perinatol 2023; 40:1437-1445. [PMID: 34634829 DOI: 10.1055/s-0041-1736286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Infants admitted to the neonatal intensive care unit (NICU) are at increased likelihood of hospital readmission when compared with non-NICU admitted infants, resulting in appreciable financial and emotional burdens. Early readmission, days to weeks, following NICU discharge, may be preventable. Population-based data identifying potentially modifiable factors and spending associated with early readmission are lacking. STUDY DESIGN We conducted a secondary data analysis of privately insured infants in the IBM MarketScan Research Database born from 2011 to 2017 in all 50 states and admitted to the NICU. We examined demographic and clinical characteristics of early readmission within 7 days and between 8 and 30 days following NICU discharge and the payments of NICU and readmission care. Data were analyzed using univariate and multivariable logistic regression. RESULTS Of the 86,741 NICU survivors analyzed, 3,131 infants (3.6%) were readmitted by 7 days and 2,128 infants (2.5%) between 8 and 30 days. Preterm infants had reduced odds of readmission by 7 days compared with term infants. Infants transferred to a step-down facility (vs. discharge home) and those with congenital anomalies had higher independent odds of readmission by 7 and 8 to 30 days. A higher percentage of NICU infants within the lowest quartile of initial NICU length of stay (LOS) were readmitted by 7 days compared with NICU infants in the middle and highest LOS quartiles (64 vs. 36%, p < 0.01). Median payments of readmissions at 7 and 8 to 30 days was $12,785 and 14,380, respectively. CONCLUSION Being term, being transferred to a step-down facility, and having a congenital anomaly were risk factors for early readmission. Shorter initial NICU LOS may be a contributing factor to readmission by 7 days, especially among term infants. These findings identify factors associated with readmission with the hope of preventing early readmission, minimizing spending, and optimizing ideal timing of NICU discharge. KEY POINTS · Preterm infants were less likely than term infants to be readmitted within 7 days after discharge.. · Transferred infants had higher odds of readmission versus those who were discharged home.. · Payments for an average single NICU day were $1,000 less than for an average day of readmission..
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Affiliation(s)
- Janine Bernardo
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amaris Keiser
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan Aucott
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa R Yanek
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clark T Johnson
- Department of OB/GYN, Anne Arundel Medical Center, Annapolis, Maryland
- Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Pamela Donohue
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Muñoz-Gómez E, Inglés M, Mollà-Casanova S, Sempere-Rubio N, Serra-Añó P, Aguilar-Rodríguez M. Effects of an Oral Stimulation Program on Feeding Outcomes in Preterm Infants: A Systematic Review and Meta-Analysis. Phys Occup Ther Pediatr 2023; 44:110-127. [PMID: 37203152 DOI: 10.1080/01942638.2023.2212767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/06/2023] [Indexed: 05/20/2023]
Abstract
AIMS To review the literature on the effects of unimodal sensorimotor stimulation protocols on feeding outcomes in very preterm and moderate to late preterm infants (PIs). METHODS Five databases were searched up to April 2022. Studies comparing unimodal sensorimotor stimulation protocols based on the combination of manual oral stimulation with NNS against usual care in PIs, on-time transition to full oral feeding (FOF), feeding efficacy, length of hospital stay, and/or body weight gain. RESULTS Eleven studies were included. Compared to usual care, unimodal sensorimotor stimulation protocols based on manual oral stimulation combined with NNS demonstrated to be more effective in decreasing time transition to FOF (standardized mean difference [95%CI] - 1.08 [-1.74, -0.41]), improving feeding efficacy (2.15 [1.18, 3.13]) and shortening length of hospital stay (-0.35 [-0.68, -0.03]). However, the proposed intervention was not effective in improving weight gain (0.27 [-0.40, 0.95]). There were no significant differences according to gestational age (p > .05). CONCLUSIONS Based on fair-to-high quality evidence, unimodal sensorimotor stimulation protocols combined with NNS reduce time transition to FOF, improve feeding efficacy, and shorten the length of hospital stay; yet the proposed intervention yielded no significant effects on body weight gain when compared to usual care in PIs.
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Affiliation(s)
- Elena Muñoz-Gómez
- UBIC Research Group, Department of Physiotherapy, Universitat de València, València, Spain
| | - Marta Inglés
- UBIC Research Group, Department of Physiotherapy, Universitat de València, València, Spain
| | - Sara Mollà-Casanova
- UBIC Research Group, Department of Physiotherapy, Universitat de València, València, Spain
| | - Núria Sempere-Rubio
- UBIC Research Group, Department of Physiotherapy, Universitat de València, València, Spain
| | - Pilar Serra-Añó
- UBIC Research Group, Department of Physiotherapy, Universitat de València, València, Spain
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Nimbalkar S, Popat V, Patel P, Pujara R, Shinde M, Patel D. Effect of Kangaroo Mother Care Transport in Preventing Moderate Hypothermia in Low Birth Weight Babies During Transportion to Home After Discharge: A Randomized Controlled Trial. Indian Pediatr 2023; 60:272-276. [PMID: 36757001 DOI: 10.1007/s13312-023-2857-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/05/2022] [Accepted: 12/27/2022] [Indexed: 09/17/2023]
Abstract
BACKGROUND Transport of neonates is often neglected, which results in high mortality of neonates during transport. OBJECTIVES To determine the effectiveness of kangaroo mother care (KMC) in terms of hypothermia prevention during transport from hospital to home for low birth weight neonates. STUDY DESIGN Randomized controlled trial. PARTICIPANTS A total of 152 low birth weight neonates being discharged from the neonatal intensive care unit of our hospital between March, 2021 and August, 2022. INTERVENTION Neonates in the study group (n=76) received KMC during transport from the hospital to home, while the control group (n=76) did not receive KMC during transport. Axillary temperature was recorded in both groups at the time of discharge, every 5 minutes during transport, and on reaching home. OUTCOMES Hypothermia episodes in neonates while receiving KMC compared to neonates not receiving KMC. RESULTS Primary endpoint of the study was moderate hypothermia. During transport, 23 (30.3%) neonates in the control group experienced moderate hypothermia during transport, which was statistically significant [0% vs 30.3%; P<0.001]. From 10 minutes of transport till the neonates reached home, the mean (SD) temperature in the study group was significantly higher than in the control group [ 36.8 (0.23) °C vs 36.6 (0.3) °C; P<0.001] at time 15 minutes. Similar results were noted in preterm neonates [36.7 (0.25) °C vs 36.5 (0.29) °C; P<0.001] at time 15 minutes. The number of hypothermia episodes was more in the control group than in the study group during most of the transport time [7.6% vs 43.2%; P<0.001] at time 15 minutes. CONCLUSIONS Low birth weight neonates receiving KMC showed optimal thermoregulation, whereas a high incidence of moderate hypothermia was seen among neonates receiving conventional care during transport.
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Affiliation(s)
- Somashekhar Nimbalkar
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat. Correspondence to: Prof Somashekhar Nimbalkar, Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat 388 325.
| | - Vedant Popat
- Department of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat
| | - Purvi Patel
- Department of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat
| | - Reshma Pujara
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat
| | - Mayur Shinde
- Central Research Service, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat
| | - Dipen Patel
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat
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Zupancic JAF, Hudak ML, Edwards EM, Horbar JD, Mao WY, Miedema D, Keels E, Pursley DM. Using the Neonatal Intensive Care Unit Wisely: A National Survey of Clinicians Regarding Practices for Lower-Acuity Care. J Pediatr 2023; 253:165-172.e1. [PMID: 36181871 DOI: 10.1016/j.jpeds.2022.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/25/2022] [Accepted: 09/23/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this study was to document the practices and preferences of neonatal care stakeholders regarding location and duration of care for newborns with low illness acuity. STUDY DESIGN We developed a survey instrument that comprised 14 questions across 2 global scenarios and 7 specific clinical conditions. The latter included apnea of prematurity, gestational age for neonatal intensive care unit admission, jaundice, neonatal opioid withdrawal, thermoregulation, and sepsis evaluation. Respondents reported their current practice and preferences for an alternative approach. We administered the survey to individuals in the membership email distribution lists of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine, the National Association of Neonatal Nurses, and the Vermont Oxford Network. RESULTS Of 2284 respondents, 53% believed that infants were, in general, admitted to a higher level of care than was required, and only 13% reported that the level of care was too low. Length of stay was perceived to be generally too long by 46% of respondents and too short by 21%. Across 10 specific clinical questions, there was substantial variability in current practice and up to 35% of respondents reported discordance between current and preferred practice. These respondents preferred a lower level of care in 8 of 10 scenarios. CONCLUSIONS A multidisciplinary sample of US clinicians reported significant variation in the level and duration of care for infants with low illness acuity. Among individuals reporting discordance between current and preferred practice, a majority believed that current management could be accomplished in a lower level of care location.
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Affiliation(s)
- John A F Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
| | - Mark L Hudak
- Department of Pediatrics, University of Florida College of Medicine - Jacksonville, Jacksonville, FL
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, VT; Department of Pediatrics, Larner College of Medicine, University of Vermont, Burlington, VT; Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT
| | - Jeffrey D Horbar
- Vermont Oxford Network, Burlington, VT; Department of Pediatrics, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Wen Yang Mao
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - David Miedema
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Erin Keels
- Nationwide Children's Hospital, Columbus, OH
| | - DeWayne M Pursley
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
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14
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Intestinal Inflammation is Significantly Associated With Length Faltering in Preterm Infants at Neonatal Intensive Care Unit Discharge. J Pediatr Gastroenterol Nutr 2022; 74:837-844. [PMID: 35442225 PMCID: PMC9296612 DOI: 10.1097/mpg.0000000000003455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of the study was to assess intestinal inflammatory measures, urinary intestinal fatty acid-binding protein (IFABP), and fecal calprotectin (FC) by gestational age (GA) and postmenstrual age (PMA) and determine the association between intestinal inflammation and growth in preterm infants from birth to hospital discharge. We hypothesized that intestinal inflammation is associated with adverse growth in preterm infants. METHODS We assayed repeated measures of IFABP and FC in 72 hospitalized preterm infants (<34 weeks' gestation). We calculated weight and length z scores at birth and discharge using the Fenton growth reference. Associations between mean IFABP or FC, growth z scores at discharge, and growth faltering (weight or length z score difference <-0.8 from birth to discharge) were assessed using mixed linear and logistic regression models, adjusted for intrafamilial correlation and potential confounders: GA, sex, birth z score, race/ethnicity, and maternal age. RESULTS Mean IFABP was greater among infants born at earlier GA and decreased with increasing PMA. Mean FC did not vary by GA or PMA. Higher mean IFABP and FC were associated with lower discharge growth z scores and greater likelihood of growth faltering significant only for mean IFABP and discharge length z score (β = -0.353, 95% confidence interval [CI]: -0.704 to -0.002) and mean IFABP and length faltering (odds ratio [OR] 1.99, P = 0.018). CONCLUSIONS Intestinal inflammation, measured by IFABP, was associated with lower length z scores and length faltering at discharge. Interventions to prevent intestinal inflammation may improve linear growth among preterm infants.
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The Trend in Costs of Tertiary-Level Neonatal Intensive Care for Neonates Born Preterm at 22 0/7-28 6/7 Weeks of Gestation from 2010 to 2019 in Canada. J Pediatr 2022; 245:72-80.e6. [PMID: 35304168 DOI: 10.1016/j.jpeds.2022.02.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the trend in costs over 10 years for tertiary-level neonatal care of infants born 220/7-286/7 weeks of gestation during an ongoing Canadian national quality improvement project. STUDY DESIGN Clinical characteristics, outcomes, and third-party payor costs for the tertiary neonatal care of infants born 220/7-286/7 weeks of gestation between the years 2010 and 2019 were analyzed from the Canadian Neonatal Network database. Costs were estimated using resource use data from the Canadian Neonatal Network and cost inputs from hospitals, physician billing, and administrative databases in Ontario, Canada. Cost estimates were adjusted to 2017 Canadian dollars (CAD). A generalized linear mixed-effects model with gamma regression was used to estimate trends in costs. RESULTS Between 2010 and 2019, the number of infants born <24 weeks of gestation increased from 4.4% to 7.7%. The average length of stay increased from 68 days to 75 days. Unadjusted average ± SD total costs per neonate were $120 717 ± $93 062 CAD in 2010 and $132 774 ± $93 161 CAD in 2019. After adjustment for year, center, and gestation, total costs and length of stay increased significantly, by $13 612 CAD (P < .01) and 8.1 days (P < .01) over 10 years, respectively; whereas costs accounting for LOS remained stable. CONCLUSIONS The total costs and length of stay for infants 220/7-286/7 weeks of gestation have increased over the past decade in Canada during an ongoing national quality improvement initiative; however, there was an increase in the number and survival of neonates at the age of periviability.
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Kramer KP, Minot K, Butler C, Haynes K, Mason A, Nguyen L, Wynn S, Liebowitz M, Rogers EE. Reduction of Severe Intraventricular Hemorrhage in Preterm Infants: A Quality Improvement Project. Pediatrics 2022; 149:184903. [PMID: 35229127 DOI: 10.1542/peds.2021-050652] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this quality improvement project was to reduce the rate of severe intraventricular hemorrhage (sIVH) by 50% within 3 years for extremely preterm infants born at a children's teaching hospital. METHODS A multidisciplinary team developed key drivers for the development of intraventricular hemorrhage in preterm infants. Targeted interventions included the development of potentially better practice guidelines, promoting early noninvasive ventilation, consistent use of rescue antenatal betamethasone, and risk-based indomethacin prophylaxis. The outcome measure was the rate of sIVH. Process measures included the rate of intubation within 24 hours and receipt of rescue betamethasone and risk-based indomethacin prophylaxis. Common markers of morbidity were balancing measures. Data were collected from a quarterly chart review and analyzed with statistical process control charts. The preintervention period was from January 2012 to March 2016, implementation period was from April 2016 to December 2018, and sustainment period was through June 2020. RESULTS During the study period, there were 268 inborn neonates born at <28 weeks' gestation or <1000 g (127 preintervention and 141 postintervention). The rate of sIVH decreased from 14% to 1.2%, with sustained improvement over 2 and a half years. Mortality also decreased by 50% during the same time period. This was associated with adherence to process measures and no change in balancing measures. CONCLUSIONS A multipronged quality improvement approach to intraventricular hemorrhage prevention, including evidence-based practice guidelines, consistent receipt of rescue betamethasone and indomethacin prophylaxis, and decreasing early intubation was associated with a sustained reduction in sIVH in extremely preterm infants.
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Affiliation(s)
- Katelin P Kramer
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Kacy Minot
- University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Colleen Butler
- University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Kathryn Haynes
- University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Amber Mason
- University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Lan Nguyen
- University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Samantha Wynn
- University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Melissa Liebowitz
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.,University of California, San Francisco, Benioff Children's Hospital, San Francisco, California
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17
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Belfort MB, Ramel SE, Martin CR, Fichorova R, Kuban KCK, Heeren T, Fry RC, O’Shea TM. Systemic Inflammation in the First 2 Weeks after Birth as a Determinant of Physical Growth Outcomes in Hospitalized Infants with Extremely Low Gestational Age. J Pediatr 2022; 240:37-43.e1. [PMID: 34508750 PMCID: PMC8712377 DOI: 10.1016/j.jpeds.2021.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine associations of systemic inflammation with growth outcomes at neonatal intensive care unit discharge or transfer among infants with extremely low gestational ages. STUDY DESIGN We studied 850 infants at born at 23-27 weeks of gestation. We defined inflammatory protein elevation as the highest quartile of C-reactive protein (CRP), Interleukin (IL)-6, tumor necrosis factor-∝, or IL-8 on postnatal days 1, 7, and 14. We compared z-scores of weight, length, and head circumference at neonatal intensive care unit discharge or transfer between infants with vs without inflammatory protein elevation, adjusting in linear regression for birth size z-score, sex, gestational age, diet, comorbidities, medications, and length of hospitalization. RESULTS The mean gestational age was 25 weeks (range, 23-27 weeks) and birth weight z-score 0.14 (range, -2.73 to 3.28). Infants with a high CRP on day 7 had lower weights at discharge or transfer (-0.17 z-score; 95% CI, -0.27 to -0.06) than infants without CRP elevation, with similar results on day 14. Infants with CRP elevation on day 14 were also shorter (-0.21 length z-scores; 95% CI, -0.38 to -0.04), and had smaller head circumferences (-0.18 z-scores; 95% CI, -0.33 to -0.04) at discharge or transfer. IL-6 elevation on day 14 was associated with lower weight (-0.12; 95% CI, -0.22 to -0.02); IL-6 elevation on day 7 was associated with shorter length (-0.27; 95% CI, -0.43 to -0.12). Tumor necrosis factor-∝ and IL-8 elevation on day 14 were associated with a lower weight at discharge or transfer. CONCLUSIONS Postnatal systemic inflammation may contribute to impaired nutrient accretion during a critical period in development in infants with extremely low gestational ages.
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Affiliation(s)
- Mandy B. Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Sara E. Ramel
- University of Minnesota School of Medicine, Minneapolis, MN
| | - Camilia R. Martin
- Harvard Medical School, Boston, MA,Beth Israel Deaconess Medical Center, Boston, MA
| | - Raina Fichorova
- Harvard Medical School, Boston, MA,Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA
| | | | | | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, University of North Carolina School of Medicine, Chapel Hill, NC
| | - T. Michael O’Shea
- Division of Neonatal-Perinatal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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18
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Fröhlich M, Tissen-Diabaté T, Bührer C, Roll S. Sex-Specific Long-Term Trends in Length of Hospital Stay, Postmenstrual Age at Discharge, and Survival in Very Low Birth Weight Infants. Neonatology 2021; 118:416-424. [PMID: 34091458 PMCID: PMC8491473 DOI: 10.1159/000515899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In very low birth weight (<1,500 g, VLBW) infants, morbidity and mortality have decreased substantially during the past decades, and both are known to be lower in girls than in boys. In this study, we assessed sex-specific changes over time in length of hospital stay (LOHS) and postmenstrual age at discharge (PAD), in addition to survival in VLBW infants. METHODS This is a single-center retrospective cohort analysis based on quality assurance data of VLBW infants born from 1978 to 2018. Estimation of sex-specific LOHS over time was based on infants discharged home from neonatal care or deceased. Estimation of sex-specific PAD over time was based on infants discharged home exclusively. Analysis of in-hospital survival was performed for all VLBW infants. RESULTS In 4,336 of 4,499 VLBW infants admitted from 1978 to 2018 with complete data (96.4%), survival rates improved between 1978-1982 and 1993-1997 (70.8 vs. 88.3%; hazard ratio (HR) 0.20, 95% confidence interval 0.14, 0.30) and remained stable thereafter. Boys had consistently higher mortality rates than girls (15 vs. 12%, HR 1.23 [1.05, 1.45]). Nonsurviving boys died later compared to nonsurviving girls (adjusted mean survival time 23.0 [18.0, 27.9] vs. 20.7 [15.0, 26.3] days). LOHS and PAD assessed in 3,166 survivors displayed a continuous decrease over time (1978-1982 vs. 2013-2018: LOHS days 82.9 [79.3, 86.5] vs. 60.3 [58.4, 62.1] days); PAD 40.4 (39.9, 40.9) vs. 37.4 [37.1, 37.6] weeks). Girls had shorter LOHS than boys (69.4 [68.0, 70.8] vs. 73.0 [71.6, 74.4] days) and were discharged with lower PAD (38.6 [38.4, 38.8] vs. 39.2 [39.0, 39.4] weeks). DISCUSSION/CONCLUSIONS LOHS and PAD decreased over the last 40 years, while survival rates improved. Male sex was associated with longer LOHS, higher PAD, and higher mortality rates.
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Affiliation(s)
- Matthias Fröhlich
- Department of Neonatology, Charité − Universitätsmedizin Berlin, Berlin, Germany
| | - Tatjana Tissen-Diabaté
- Institute for Social Medicine, Epidemiology and Health Economics, Charité − Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité − Universitätsmedizin Berlin, Berlin, Germany
| | - Stephanie Roll
- Institute for Social Medicine, Epidemiology and Health Economics, Charité − Universitätsmedizin Berlin, Berlin, Germany
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Arnold C, Davis AS. Increasing Length of Stay in the NICU for Premature Newborns: Good or Bad? Pediatrics 2021; 147:peds.2020-032748. [PMID: 33510033 DOI: 10.1542/peds.2020-032748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Cody Arnold
- Division of Neonatology, Department of Pediatrics, The University of Texas Health Sciences Center at Houston McGovern Medical School, Houston, Texas; and
| | - Alexis S Davis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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