Related Experiment Video
Updated: Jun 22, 2026
Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
Published on: November 20, 2015
Moderately preterm infants and determinants of length of hospital stay
M Altman1, M Vanpée, S Cnattingius
1Department of Clinical Science, Intervention and Technology, Karolinska Institutet, B57 Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden. maria.altman@ki.se
Insights
Hospital discharge for preterm infants (30-34 weeks GA) is minimally impacted by risk factors. Care organization significantly influences length of stay, affecting neonatal unit bed-days.
Area of Science:
- Neonatalogy
- Pediatrics
- Public Health
Background:
- Moderately preterm infants (30-34 weeks gestational age) represent a significant burden on neonatal unit resources.
- Current management strategies and factors influencing their length of hospital stay are not well understood.
Purpose of the Study:
- To determine the postmenstrual age (PMA) at hospital discharge for moderately preterm infants.
- To investigate the relationship between perinatal risk factors, care organization, and discharge timing.
Main Methods:
- A population-based cohort study included 2388 infants born between 2004-2005 with gestational age 30-34 weeks.
- Infants were admitted to 21 neonatal units reporting to the Swedish perinatal register.
Main Results:
- Mean postmenstrual age (PMA) at discharge was 36.9 weeks.
- Maternal age, multiple birth, SGA, RDS, infection, hypoglycemia, and hyperbilirubinemia were associated with longer stays but explained only 13% of variation.
- Discharge timing varied by up to 2 weeks between hospitals; fixed discharge criteria and domiciliary care reduced length of stay.
Conclusions:
- Perinatal risk factors have a limited impact on the length of hospital stay for moderately preterm infants.
- The organization of neonatal care appears to be a crucial factor influencing discharge timing and bed-day utilization.
- Significant inter-center variations in bed-day use highlight potential impacts on care quality and healthcare economics.
Background:
Moderately preterm infants account for a large proportion of admissions and bed-days in neonatal units (NU). Management of these infants varies and determinants of length of stay are poorly studied.
Objective:
To determine postmenstrual age at hospital discharge for moderately preterm infants and its relation to perinatal risk factors and to organisation of care.
Methods:
Population-based cohort including 2388 infants, born in 2004-2005 with a gestational age (GA) of 30-34 weeks and admitted to 21 NU reporting to the Swedish perinatal register.
Main Outcome:
postmenstrual age (PMA) at hospital discharge to home.
Results:
Mean PMA at hospital discharge was 36.9 (1.7) weeks. High (> or = 35 years) maternal age, multiple birth, small for gestational age, respiratory distress syndrome, infection, hypoglycaemia and hyperbilirubinaemia were significantly associated with higher PMA at discharge, but could only explain 13% of the variation in PMA at discharge. Mean PMA at discharge differed by up to 2 weeks between hospitals. Infants treated at NUs without fixed discharge criteria had 4.7 days lower PMA at discharge and infants receiving domiciliary care had 9.8 days lower PMA at discharge. Breastfed infants also had lower PMA at discharge (mean 2.7 days lower) than those not breast fed, partly explained by lower morbidity in the breastfed infants.
Conclusions:
Perinatal risk factors have small overall impact on length of hospital stay in moderately preterm infants. Organisation of care is probably an important factor. The number of bed-days differs significantly between centres, which may have effects on quality of care and health economy.
