Variation in Length of Stay by Level of Neonatal Care Among Moderate and Late Preterm Infants

Area of Science:

• Neonatal care
• Pediatric hospital outcomes
• Healthcare quality and safety

Background:

• Moderate and late preterm infants represent a growing population with complex care needs.
• Standardized care protocols for these infants are currently lacking.
• Variations in length of stay (LOS) may impact resource utilization and patient outcomes.

Purpose of the Study:

• To analyze variations in LOS for moderate (32-33 weeks gestational age [GA]) and late (34-36 weeks GA) preterm infants.
• To compare LOS across different levels of neonatal care (II, III, and IV) and within hospitals of the same level.
• To identify factors contributing to LOS variability in this population.

Main Methods:

• Retrospective cohort study utilizing the 2019 Kid's Inpatient Database.
• Inclusion of hospitalizations for moderate and late preterm infants.
• Statistical analysis to compare adjusted LOS, accounting for patient-level and hospital-level factors.

Main Results:

• The study included over 217,000 moderate and late preterm infants across level II, III, and IV hospitals.
• Patient and hospital-level factors significantly influenced LOS.
• Level II hospitals exhibited the greatest variability in LOS for 34- to 36-week GA infants; significant variation also observed between level III and IV hospitals for 32-week GA infants.

Conclusions:

• The level of neonatal care is associated with significant variation in LOS for moderate and late preterm infants, even after adjusting for clinical severity.
• Level II neonatal care facilities demonstrated the highest degree of LOS variability.
• Standardization of care within level II hospitals may be a key area for quality improvement initiatives.