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  • Original Article
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Prolonged Hospital Stay for Extremely Premature Infants: Risk Factors, Center Differences, and the Impact of Mortality on Selecting a Best-Performing Center

Abstract

OBJECTIVE:

The first objective was to identify factors associated with prolonged hospital stay (PHS: hospitalized >42 weeks postmenstrual age) in extremely premature (EP: born less than or equal to 28 weeks gestation) infants. The second objective was to identify a PHS best-performing benchmark center.

METHODS:

This study was a retrospective cohort analysis of infants born ≤28 weeks gestation and admitted to one of 12 tertiary centers between January 1998 and October 2001. Risk-adjusted odds of PHS, defined as hospitalization beyond 42 weeks postmenstrual age, and the competing outcome, mortality, were assessed using logistic regression models.

RESULTS:

Among 3892 EP survivors who had complete data for multivariable analysis, 685 (18%) had PHS. Variables contributing to PHS included chronic lung disease (oxygen use at discharge home or 36 week postmenstrual age) (OR 6.75; 95% CI: 5.04 to 9.03), necrotizing enterocolitis requiring surgery (OR 13.83; 95% CI: 8.05 to 23.76), and >two episodes of late-onset sepsis (OR 2.39; 95% CI: 1.66 to 3.44). Centers’ risk-adjusted PHS odds differed from the reference center, which had the lowest incidence of PHS and mortality (overall P-value <0.0001). Mortality contributed to PHS, but in an opposite direction compared to other factors. Centers with lowest PHS odds were among those with highest mortality.

CONCLUSIONS:

These findings suggest that reduction of CLD, surgical NEC, and late onset sepsis could reduce PHS in EP infants. Risk adjusted odds of PHS and mortality are both crucial for selecting a PHS best-performing center.

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Acknowledgements

This study was supported by National Institute of Health Grant numbers: U10 HD27904, U10 HD21364, U10 HD27851, U10 HD34167, U10 HD27856, U10 HD27880, U10 HD34216, U10 HD27853, U10 HD21397, U10 HD27881, U10 HD21415, U10 HD40689, U10 HD 21373, U10 HD21385, U10 HD27871, U01 HD36790. The following centers (PI; coordinator) participated in the Network during study subject enrollment: Brown University (William Oh, MD; Angelita Hensman, RN), Case Western Reserve University (Avroy A. Fanaroff, MB, BCh; Nancy Newman, RN), Emory Universtiy (Barbara J. Stoll, MD; Ellen Hale, RN), Harvard University (Ann R. Stark, MD; Kerri Fournier, RN), Indiana University (James A. Lemons, MD; DeeDee Appel, RN), Stanford University (David K. Stevenson, MD; Bethany Ball, BS), University of Alabama (Waldemar A. Carlo, MD; Monica Collins, RN), University of Cincinnati (Edward F. Donovan, MD; Marcia Mersmann, RN), University of Miami (Charles R. Bauer, MD; Amy Mur Worth, BSN), University of New Mexico (Lu-Ann Papile, MD; Conra Backstrom, RN), University of Tennessee (Sheldon B. Korones, MD; Tina Hudson, RN), University of Texas-Dallas (Abbot R. Laptook, MD; Susie Madison, RN), University of Texas-Houston (Jon E. Tyson, MD, MPH; Georgia McDavid, RN), Wayne State University (Seetha Shankaran, MD; Gerry Muran, BSN), Yale University (Richard A. Ehrenkranz; Pat Gettner, RN), NICHD (Linda L. Wright, MD; Beth McClure Med); Steering Committee Chairman: Alan H. Jobe, MD, PhD.

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This study was presented, in part, at the Pediatric Academic Societies Meeting, Baltimore, Maryland, May 6, 2002.

None of the authors has any potential conflict of interest, real or perceived.

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Michael Cotten, C., Oh, W., McDonald, S. et al. Prolonged Hospital Stay for Extremely Premature Infants: Risk Factors, Center Differences, and the Impact of Mortality on Selecting a Best-Performing Center. J Perinatol 25, 650–655 (2005). https://doi.org/10.1038/sj.jp.7211369

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