Comparison of short-term outcomes of 35-weeks' gestation infants cared for in a level II NICU vs mother-baby, a retrospective study

Variation in NICU utilization: a narrative review and path forward

Utilization of the Neonatal Intensive Care Unit (NICU) varies widely in the United States. Over recent decades, there has been a growth in NICUs, that varies by region, and has not been correlated to changes in demand or illness severity. Unnecessary NICU admissions are costly, stressful to families, may increase the risk of hospital acquired morbidities, and decrease breast feeding. Most of the variation in NICU utilization is based on the care of late preterm, early term, and term babies and is related to hospital level factors, including financial incentives, driving utilization. Improvement strategies to reduce variation include regionalization of care, certificate of need legislation, improving discharge processes, and caring for babies with some conditions such as Neonatal Opioid Withdrawal Syndrome or those with risk factors for sepsis outside of the NICU.

Characteristics of late preterm infant readmissions: A systematic review

BACKGROUND

Prematurity represents a critical health disparity. It is important to note that late preterm (LPT) infants comprise the majority of preterm births, yet they are the least studied within the premature population. Evidence-based practice guidelines are now a decade old, indicating the potential need for review and revision.

OBJECTIVES

This systematic review proposed the assessment of sociodemographic characteristics of LPT infants, clinical practice standards, and associated hospital readmission rates, mortality, and morbidity to determine the need for revision of evidence-based practice guidelines for these infants.

DATA SOURCES

The Preferred Reporting System Items for Systematic Reviews and Meta Analysis methodology provided the framework for the completion of this review. Literature searches of PubMed/Medline (Ovid), Web of Science, Cumulative Index of Nursing, and Allied Health Literature Plus databases and citation searches included articles published after 2012 using the search terms "late preterm infants," "readmissions," and "readmission rates."

CONCLUSIONS

The literature search identified 11 studies meeting search criteria. These studies included quasi experimental, retrospective, and prospective cohort studies. These studies highlighted the characteristics of LPT infants that potentially contribute to increased readmission rates, morbidity and mortality rates, health care costs, and long-term health inequities. Overall findings indicate the need for review and revision of evidence-based practice guidelines for these infants.

IMPLICATIONS FOR PRACTICE

This systematic review manifests the vulnerability of LPT infants and the accompanying need for up-to-date clinical practice guidelines to effectively reduce their morbidity and mortality rates, hospital readmissions rates, and burden of health care costs.

Variation in Length of Stay by Level of Neonatal Care Among Moderate and Late Preterm Infants

BACKGROUND AND OBJECTIVES

Moderate and late preterm infants are a growing subgroup of neonates with increased care needs after birth, yet standard protocols are lacking. We aim to describe variation in length of stay (LOS) by gestational age (GA) across hospitals within the same level of neonatal care and between different levels of neonatal care.

METHODS

Retrospective cohort study of hospitalizations for moderate (32-33 weeks GA) and late (34-36 weeks GA) preterm infants in 2019 Kid's Inpatient Database. We compared adjusted LOS in this cohort and evaluated variation within hospitals of the same level and across different levels of neonatal care.

RESULTS

This study includes 217 051 moderate (26.2%) and late (73.8%) preterm infants from level II (19.7%), III (66.3%), and IV (11.1%) hospitals. Patient-level (race and ethnicity, primary payor, delivery type, multiple gestation, birth weight) and hospital-level (birth region, level of neonatal care) factors were significantly associated with LOS. Adjusted mean LOS varied for hospitals within the same level of neonatal care with level II hospitals showing the greatest variability among 34- to 36- week GA infants when compared with level III and IV hospitals (P < .01). LOS also varied significantly between levels of neonatal care with the greatest variation (0.9 days) seen in 32-week GA between level III and level IV hospitals.

CONCLUSIONS

For moderate and late preterm infants, the level of neonatal care was associated with variation in LOS after adjusting for clinical severity. Hospitals providing level II neonatal care showed the greatest variation and may provide an opportunity to standardize care.