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 |
|---|---|
| Pages (from-to) | 650-655 |
| Number of pages | 6 |
| Journal | Journal of Perinatology |
| Volume | 25 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2005 |
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ASJC Scopus subject areas
- Obstetrics and Gynecology
- Pediatrics, Perinatology, and Child Health
Cite this
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, DeeDee D.; 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, 01.10.2005, p. 650-655.Research output: Contribution to journal › Article
}
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, DeeDee D.
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.
PY - 2005/10/1
Y1 - 2005/10/1
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.
UR - http://www.scopus.com/inward/record.url?scp=27144482725&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=27144482725&partnerID=8YFLogxK
U2 - 10.1038/sj.jp.7211369
DO - 10.1038/sj.jp.7211369
M3 - Article
C2 - 16079906
AN - SCOPUS:27144482725
VL - 25
SP - 650
EP - 655
JO - Journal of Perinatology
JF - Journal of Perinatology
SN - 0743-8346
IS - 10
ER -