Prolonged hospital stay for extremely premature infants: Risk factors, center differences, and the impact of mortality on selecting a best-performing center

C. Michael Cotten; William Oh; Scott McDonald; Waldemar Carlo; Avroy A. Fanaroff; Shahnaz Duara; Barbara Stoll; Abbot Laptook; Kenneth Poole; Linda L. Wright; Ronald N. Goldberg; A. Angelita Hensman; Nancy Newman; Ellen Hale; Ann R. Stark; Kerri Fournier; James A. Lemons; Dee Dee Appel; David K. Stevenson; Bethany Ball; Monica Collins; Edward F. Donovan; Marcia Mersmann; Charles R. Bauer; Amy Mur Worth; Lu Ann Papile; Conra Backstrom; Sheldon B. Korones; Tina Hudson; Susie Madison; Jon E. Tyson; Georgia McDavid; Seetha Shankaran; Gerry Muran; Richard A. Ehrenkranz; Pat Gettner; Beth McClure; Alan H. Jobe

doi:10.1038/sj.jp.7211369

Prolonged hospital stay for extremely premature infants: Risk factors, center differences, and the impact of mortality on selecting a best-performing center

C. Michael Cotten, William Oh, Scott McDonald, Waldemar Carlo, Avroy A. Fanaroff, Shahnaz Duara, Barbara Stoll, Abbot Laptook, Kenneth Poole, Linda L. Wright, Ronald N. Goldberg, A. Angelita Hensman, Nancy Newman, Ellen Hale, Ann R. Stark, Kerri Fournier, James A. Lemons, Dee Dee Appel, David K. Stevenson, Bethany BallMonica Collins, Edward F. Donovan, Marcia Mersmann, Charles R. Bauer, Amy Mur Worth, Lu Ann Papile, Conra Backstrom, Sheldon B. Korones, Tina Hudson, Susie Madison, Jon E. Tyson, Georgia McDavid, Seetha Shankaran, Gerry Muran, Richard A. Ehrenkranz, Pat Gettner, Beth McClure, Alan H. Jobe

Pediatrics

Research output: Contribution to journal › Article › peer-review

54 Scopus citations

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.

Original language	English (US)
Pages (from-to)	650-655
Number of pages	6
Journal	Journal of Perinatology
Volume	25
Issue number	10
DOIs	https://doi.org/10.1038/sj.jp.7211369
State	Published - Oct 2005

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Obstetrics and Gynecology

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Cotten, C. M., Oh, W., McDonald, S., Carlo, W., Fanaroff, A. A., Duara, S., Stoll, B., Laptook, A., Poole, K., Wright, L. L., Goldberg, R. N., Hensman, A. A., Newman, N., Hale, E., Stark, A. R., Fournier, K., Lemons, J. A., Appel, D. D., Stevenson, D. K., ... Jobe, A. H. (2005). Prolonged hospital stay for extremely premature infants: Risk factors, center differences, and the impact of mortality on selecting a best-performing center. Journal of Perinatology, 25(10), 650-655. https://doi.org/10.1038/sj.jp.7211369

Prolonged hospital stay for extremely premature infants : Risk factors, center differences, and the impact of mortality on selecting a best-performing center. / Cotten, C. Michael; Oh, William; McDonald, Scott; Carlo, Waldemar; Fanaroff, Avroy A.; Duara, Shahnaz; Stoll, Barbara; Laptook, Abbot; Poole, Kenneth; Wright, Linda L.; Goldberg, Ronald N.; Hensman, A. Angelita; Newman, Nancy; Hale, Ellen; Stark, Ann R.; Fournier, Kerri; Lemons, James A.; Appel, Dee Dee; Stevenson, David K.; Ball, Bethany; Collins, Monica; Donovan, Edward F.; Mersmann, Marcia; Bauer, Charles R.; Mur Worth, Amy; Papile, Lu Ann; Backstrom, Conra; Korones, Sheldon B.; Hudson, Tina; Madison, Susie; Tyson, Jon E.; McDavid, Georgia; Shankaran, Seetha; Muran, Gerry; Ehrenkranz, Richard A.; Gettner, Pat; McClure, Beth; Jobe, Alan H.

In: Journal of Perinatology, Vol. 25, No. 10, 10.2005, p. 650-655.

Research output: Contribution to journal › Article › peer-review

Cotten, CM, Oh, W, McDonald, S, Carlo, W, Fanaroff, AA, Duara, S, Stoll, B, Laptook, A, Poole, K, Wright, LL, Goldberg, RN, Hensman, AA, Newman, N, Hale, E, Stark, AR, Fournier, K, Lemons, JA, Appel, DD, Stevenson, DK, Ball, B, Collins, M, Donovan, EF, Mersmann, M, Bauer, CR, Mur Worth, A, Papile, LA, Backstrom, C, Korones, SB, Hudson, T, Madison, S, Tyson, JE, McDavid, G, Shankaran, S, Muran, G, Ehrenkranz, RA, Gettner, P, McClure, B & Jobe, AH 2005, 'Prolonged hospital stay for extremely premature infants: Risk factors, center differences, and the impact of mortality on selecting a best-performing center', Journal of Perinatology, vol. 25, no. 10, pp. 650-655. https://doi.org/10.1038/sj.jp.7211369

Cotten, C. Michael ; Oh, William ; McDonald, Scott ; Carlo, Waldemar ; Fanaroff, Avroy A. ; Duara, Shahnaz ; Stoll, Barbara ; Laptook, Abbot ; Poole, Kenneth ; Wright, Linda L. ; Goldberg, Ronald N. ; Hensman, A. Angelita ; Newman, Nancy ; Hale, Ellen ; Stark, Ann R. ; Fournier, Kerri ; Lemons, James A. ; Appel, Dee Dee ; Stevenson, David K. ; Ball, Bethany ; Collins, Monica ; Donovan, Edward F. ; Mersmann, Marcia ; Bauer, Charles R. ; Mur Worth, Amy ; Papile, Lu Ann ; Backstrom, Conra ; Korones, Sheldon B. ; Hudson, Tina ; Madison, Susie ; Tyson, Jon E. ; McDavid, Georgia ; Shankaran, Seetha ; Muran, Gerry ; Ehrenkranz, Richard A. ; Gettner, Pat ; McClure, Beth ; Jobe, Alan H. / Prolonged hospital stay for extremely premature infants : Risk factors, center differences, and the impact of mortality on selecting a best-performing center. In: Journal of Perinatology. 2005 ; Vol. 25, No. 10. pp. 650-655.

@article{7750acea37e94e0e8adfbaa6361ac22c,

title = "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.",

author = "Cotten, {C. Michael} and William Oh and Scott McDonald and Waldemar Carlo and Fanaroff, {Avroy A.} and Shahnaz Duara and Barbara Stoll and Abbot Laptook and Kenneth Poole and Wright, {Linda L.} and Goldberg, {Ronald N.} and Hensman, {A. Angelita} and Nancy Newman and Ellen Hale and Stark, {Ann R.} and Kerri Fournier and Lemons, {James A.} and Appel, {Dee Dee} and Stevenson, {David K.} and Bethany Ball and Monica Collins and Donovan, {Edward F.} and Marcia Mersmann and Bauer, {Charles R.} and {Mur Worth}, Amy and Papile, {Lu Ann} and Conra Backstrom and Korones, {Sheldon B.} and Tina Hudson and Susie Madison and Tyson, {Jon E.} and Georgia McDavid and Seetha Shankaran and Gerry Muran and Ehrenkranz, {Richard A.} and Pat Gettner and Beth McClure and Jobe, {Alan H.}",

note = "Funding Information: 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.",

year = "2005",

month = oct,

doi = "10.1038/sj.jp.7211369",

language = "English (US)",

volume = "25",

pages = "650--655",

journal = "Journal of Perinatology",

issn = "0743-8346",

publisher = "Nature Publishing Group",

number = "10",

}

TY - JOUR

T1 - Prolonged hospital stay for extremely premature infants

T2 - Risk factors, center differences, and the impact of mortality on selecting a best-performing center

AU - Cotten, C. Michael

AU - Oh, William

AU - McDonald, Scott

AU - Carlo, Waldemar

AU - Fanaroff, Avroy A.

AU - Duara, Shahnaz

AU - Stoll, Barbara

AU - Laptook, Abbot

AU - Poole, Kenneth

AU - Wright, Linda L.

AU - Goldberg, Ronald N.

AU - Hensman, A. Angelita

AU - Newman, Nancy

AU - Hale, Ellen

AU - Stark, Ann R.

AU - Fournier, Kerri

AU - Lemons, James A.

AU - Appel, Dee Dee

AU - Stevenson, David K.

AU - Ball, Bethany

AU - Collins, Monica

AU - Donovan, Edward F.

AU - Mersmann, Marcia

AU - Bauer, Charles R.

AU - Mur Worth, Amy

AU - Papile, Lu Ann

AU - Backstrom, Conra

AU - Korones, Sheldon B.

AU - Hudson, Tina

AU - Madison, Susie

AU - Tyson, Jon E.

AU - McDavid, Georgia

AU - Shankaran, Seetha

AU - Muran, Gerry

AU - Ehrenkranz, Richard A.

AU - Gettner, Pat

AU - McClure, Beth

AU - Jobe, Alan H.

N1 - Funding Information: 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.

PY - 2005/10

Y1 - 2005/10

N2 - 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.

AB - 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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