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In our recent paper1 we provided estimates of length of stay for very preterm (24–31 weeks gestational age) singleton babies admitted for neonatal care in units within England. As with much neonatal research, we chose to exclude multiples (twins, triplets and higher order; in this letter referred to as ‘multiples’) from this initial work. However, as around 1 in 10 twins are born before 32 weeks, compared with around 1 in 100 singleton births,2 it is important to be able to also estimate the length of stay for these babies to aid the planning of healthcare resources and facilitate the counselling of their parents.
We were interested in whether the estimates of length of stay from the singleton population could be applied to multiples without the need to calculate new estimates. Data related to multiples admitted to neonatal units in England equivalent to the singletons was extracted from the National Neonatal Research Database. A total of 7496 babies met the inclusion criteria as described elsewhere1: 6755 twins and 741 triplets or higher order.
We calculated the observed median (25th, 75th centiles) length of stay for multiples by week of gestational age at birth and compared it with that estimated previously for singletons (table 1). Across all gestational ages, the median length of stay for multiples was very similar to their singleton peers, with the largest difference being 3 days. Larger differences were observed at the 25th centile, indicating that the discharge of multiples began later than for singletons. The discharge of sibling multiples is not likely to be independent, with units potentially attempting to get siblings home at the same time. Indeed in our data, for sets of twins who survived to discharge, 68% were discharged on the same day.
We have demonstrated that the length of stay for multiples is similar to singletons, and therefore the broad estimates used for singletons may be appropriate for all very preterm babies. However, we do not suggest that the exact estimates provided here should be used, but rather they can complement clinical knowledge. For example, for babies with an estimated median length of stay of 126 days, clinicians may wish to describe this as ‘around 4 months’ when a conversation about length of stay is appropriate. This conversation should be considered alongside the risk of mortality, and clinical complications which an individual baby may experience.
As with singleton babies, there is no evidence to suggest that there is an optimal length of stay that is appropriate or safe for the baby. Future work is needed to consider length of stay against longer-term outcomes including readmission following discharge from neonatal care. However, the counselling around potential length of stay is vital to ensure parents feel prepared3 4 for their baby’s discharge home. These estimates can be used for all very preterm babies, alongside clinical knowledge, to facilitate the conversations between clinicians and parents.
Acknowledgments
Theauthors would like to thank all the neonatal units that allowed their data tobe used in this work. We would like to thank t he Lead Clinicians of theUK Neonatal Collaborative: Dr Matthew Babirecki, Dr Anand Kamalanathan, Dr TimWickham, Dr Kavi Aucharaz, Dr Aashish Gupta, Dr Nicola Paul, Dr L M Wong, DrAnita Mittal, Dr Penny Broggio, Dr Pinki Surana, Dr Anju Singh, Dr Sunita Seal,Dr Ahmed Hassan, Dr Karin Schwarz, Dr Mark Thomas, Dr Aiwyne Foo, Dr JoAnderson, Dr Graham Whincup, Dr Stephen Brearey, Dr John Chang, Dr Khairy Gad, DrAbdul Hasib, Dr Mehdi Garbash, Dr Alex Allwood, Dr Pauline Adiotomre, Dr NigelBrooke, Dr Abby Deketelaere, Dr K Abdul Khader, Dr Ruth Shephard, Dr SanghaviRekha, Dr Belal Abuzgia, Dr Mukta Jain, Dr Simon Pirie, Dr Pinki Surana, DrStanley Zengeya, Dr Timothy Watts, Dr Sobia Balal, Dr Cath Seagrave, Dr TristanBate, Dr Hilary Dixon, Dr Narendra Aladangady, Dr Hassan Gaili, Dr MatthewJames, Dr M Lal, Dr Ambadkar, Dr Poornima Pandey, Dr Ann Hickey, Dr SimonRhodes, Dr Vinay Pai, Dr Meera Lama, Dr Lawrence Miall, Dr Jonathan Cusack, DrVenkatesh Kairamkonda, Dr Michael Grosdenier, Dr Kollipara, Dr J Kefas, Dr Bill Yoxall, Dr Jennifer Birch, DrGail Whitehead, Dr Krishnamurthy, Dr Palaniappan Sashikumar, Dr I Misra, DrTilly Pillay, Dr Imdad Ali, Dr Mark Dyke, Dr Michael Selter, Dr P Kamath, DrLesley Alsford, Vivien Spencer, Dr Subodh Gupta, Dr Richard Nicholl, Dr StevenWardle, Dr Sandip Chakrabarti, Dr Eleri Adams, Dr Katharine McDevitt, Dr AjayReddy, Dr David Gibson, Prof Minesh Khashu, Dr Chinnappa Reddy, Dr FreyaPearson, Dr P Amess, Dr Deshpande, Dr Elizabeth Sleight, Dr Charlotte Groves, DrSunit Godambe, Dr Dennis Bosman, Dr Glynis Rewitzky, Dr Olutoyin Banjoko, Dr NKumar, Dr Dominic Muogbo, Dr Wilson Lopez, Dr Angela D’Amore, Dr ShameelMattara, Dr Christos Zipitis, Dr Peter De Halpert, Dr Paul Settle, Dr PaulMunyard, Dr John McIntyre, Dr David Bartle, Dr Katie Pain, Dr Joanne Fedee, DrNatasha Maddock, Dr Richa Gupta, Dr Alison Moore, Dr Charles Godden, Dr P Amess,Dr Stephen Jones, Dr Alan Fenton, Dr Mahadevan, Dr Nick Brown, Dr Kirsten Mack,Dr Pauline Adiotomre, Dr Rob Bolton, Dr Vineet Gupta, Dr Paul Mannix, DrCharlotte Huddy, Dr Salim Yasin, Dr Sian Butterworth, Dr Sunit Godambe, DrSajit Nedungadi, Dr Pamela Cairns, Dr Peter Reynolds, Dr Nick Brennan, DrCarrie Heal, Dr Sanjay Salgia, Dr Majd Abu-Harb, Dr Jacqeline Birch, Dr Chris Knight,Dr Simon Clark, Dr Marice Theron, Dr Vadivelam Murthy, Dr Siba Paul, Dr HamudiKisat, Dr Giles Kendall, Dr Kate Blake, Dr Ozioma Obi, Dr Mehdi Garbash, DrHari Kumar, Dr Chris Rawlingson, Dr Delyth Webb, Dr Bird, Dr Sankara Narayanan,Dr Elizabeth Eyre, Dr Ian Evans, Dr Rekha Sanghavi, Dr Caroline Sullivan, DrRos Garr, Dr Wynne Leith, Dr Vimal Vasu, Dr Liza Harry, Dr Katia Vamvakiti, DrGopi Vemuri, Dr Megan Eaton, Dr Mahmoud Samy
Footnotes
Twitter @SarahESeaton
Contributors SES conceived the idea and undertook the analysis, under the supervision of BNM, ESD and KRA. SES wrote the first draft of the paper. NM provided clinical context and medical insight. All authors contributed towards the manuscript, revising it critically for intellectual content. All authors have read and approved this final version of the manuscript.
Funding This study was funded by Research Trainees Coordinating Centre (grant number: DRF-2013-06-011, NF-SI-0512-10159).
Competing interests None declared.
Patient consent Not required.
Ethics approval Permission was granted to use anonymised data from the NNRD for research purposes (Reference: 14/NW/0349, North West—Lancaster Research Ethics Committee) and agreement was obtained from all neonatal units in England that existed in 2014 to use their data for this project.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data used in this study can be obtained from the Neonatal Data Analysis Unit. More information can be found at: http://www.imperial.ac.uk/neonatal-data-analysis-unit/neonatal-data/utilising-the-nnrd/
Collaborators on behalf of the UK Neonatal Collaborative.