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Risk factors for delayed discharge home in very-low-birthweight infants:- a population-based study
Gil Klinger1, Brian Reichman, Lea Sirota
1Department of Neonatal Intensive Care, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. gilki@post.tau.ac.il
Insights
Very-low-birthweight (VLBW) infants with congenital anomalies or severe preterm birth complications face higher risks of delayed discharge. Identifying these infants early can improve outcomes and reduce prolonged hospital stays.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Public Health
Background:
- Delayed discharge for very-low-birthweight (VLBW) infants contributes significantly to healthcare resource utilization.
- Understanding risk factors for delayed discharge is crucial for optimizing care and resource allocation in neonatal intensive care units.
Purpose of the Study:
- To identify independent risk factors associated with delayed discharge in a population-based cohort of very-low-birthweight (VLBW) infants.
- To inform targeted interventions for infants at risk of prolonged hospitalization.
Main Methods:
- Utilized a national population-based database of VLBW infants born between 1995 and 2002.
- Employed multivariate analysis to determine associations between various factors and delayed discharge (postmenstrual age >42 weeks).
Main Results:
- Delayed discharge affected 9.4% of survivors but accounted for 19.8% of total hospital days.
- Independent risk factors for delayed discharge included decreasing birthweight, congenital anomalies, bronchopulmonary dysplasia, severe intraventricular hemorrhage, sepsis, and necrotizing enterocolitis.
Conclusions:
- Very-low-birthweight infants with congenital anomalies or severe complications of preterm birth are at significantly increased risk for delayed discharge.
- Early identification of at-risk VLBW infants is essential for implementing interventions to shorten hospitalization and facilitate a smoother transition home.
Aim:
To identify risk factors for delayed discharge home in a population-based cohort of very-low-birthweight (VLBW) infants.
Methods:
Demographic, pregnancy, perinatal, and neonatal data were collected in a national population-based database on VLBW infants born from 1995 through 2002. Multivariate analysis determined association with delayed discharge (discharge at a postmenstrual age >42 completed weeks).
Results:
882 infants with delayed discharge comprised 9.4% of survivors but accounted for 19.8% of total hospital days utilized until discharge home. Infants with delayed discharge compared to those discharged by term were born at an earlier mean gestational age, at a lower mean birthweight, and had a longer mean hospital stay. Delayed discharge was independently associated with decreasing birthweight (OR 1.25, 95% CI 1.19, 1.31), congenital anomalies (OR 4.80, 95% CI 3.66, 6.28), bronchopulmonary dysplasia (OR 5.88, 95% CI 4.60, 7.57), intraventricular hemorrhage grades 3-4 (OR 1.78, 95% CI 1.34, 2.36), sepsis (OR 1.87, 95% CI 1.54, 2.26), and surgically treated necrotizing enterocolitis (OR 20.20, 95% CI 12.85, 32.03).
Conclusion:
VLBW infants with congenital anomalies or severe complications of preterm birth are at increased risk for delayed discharge home. Early identification of these infants may enable interventions aimed at reducing the detrimental effects of prolonged hospitalization and promoting optimal transition from the hospital to the home environment.
