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, DeeDee D. 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

Research output: Contribution to journalArticle

50 Citations (Scopus)

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 languageEnglish
Pages (from-to)650-655
Number of pages6
JournalJournal of Perinatology
Volume25
Issue number10
DOIs
StatePublished - Oct 1 2005

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Extremely Premature Infants
Length of Stay
Mortality
Sepsis
Logistic Models
Benchmarking
Pregnancy
Necrotizing Enterocolitis
Lung Diseases
Survivors
Hospitalization
Chronic Disease
Cohort Studies
Oxygen
Incidence

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 journalArticle

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, 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. / 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.
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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, {DeeDee D.} 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.}",
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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

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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.

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