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Respiratory insufficiency, feeding issues and length of stay in 33-36 weeks post-menstrual age infants
Anjeline Bukhari1, Zahraa Dawoud1, Selphee Tang2
1Departments of Pediatrics, University of Calgary, Calgary, Canada.
Insights
This study reveals that respiratory issues and feeding delays significantly impact length of stay for preterm infants (33-36 weeks post-menstrual age). Achieving gavage-free feeding is key for early discharge, highlighting the need for individualized care plans.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Perinatal Research
Background:
- Limited data exist on morbidities and length of stay (LOS) stratified by post-menstrual age (PMA) for preterm infants between 33-36 weeks PMA.
- This PMA range represents over 80% of all preterm infants, making targeted research crucial for this population.
Purpose of the Study:
- To investigate the incidence, types, and interactions of morbidities that prolong LOS in preterm infants born at 33-36 weeks PMA.
- To identify clinical variables associated with shorter or longer than median LOS at each PMA within this range.
- To provide data facilitating evidence-based clinical care, resource planning, and parental counseling for this significant preterm infant group.
Main Methods:
- Visual review of electronic and bedside charts for 1209 preterm infants.
- Analysis of major outcomes including respiratory support and achievement of gavage-free feeding.
- Statistical analysis using Fisher's exact tests, ANOVA, and logistic regression to identify factors associated with LOS.
Main Results:
- Length of stay (LOS) varied significantly between and within post-menstrual ages (PMA) of 33-36 weeks.
- Respiratory support rates were highest at 33 weeks (63%) and decreased with advancing PMA.
- Multiple births, low birth weight, SGA status, respiratory support, RDS, delayed gavage-free feeds, and birthplace were linked to longer LOS; gavage-free feeding was the main determinant of early discharge.
Conclusions:
- Respiratory insufficiency, type of support, feeding delays, and LOS are interdependent and PMA-specific in preterm infants (33-36 weeks).
- A novel approach identified clinical variables affecting LOS, emphasizing PMA-specific care.
- Preterm infants in this PMA range should not be grouped, and PMA alone is insufficient for discharge planning or parental counseling.
Background/Aims:
Limited post-menstrual age (PMA) stratified data are available for the morbidities and length of stay (LOS) for the largest group of preterm infants. We investigated the incidence, types and interactions of morbidities that prolong the LOS at 33-36 weeks PMA.
Methods:
Electronic and bedside charts of 1209 infants were visually reviewed. Major outcomes included respiratory support, achievement of gavage-free feeding and maternal/infant variables associated with shorter/longer than Median LOS. Fisher's exact tests/ANOVA/logistic regression were used for statistical analyses.
Results:
The Median (IQR, Range) of the LOS were distinct at each and even within PMA between 33 and 36 weeks (P < 0.001). 63% of infants born at 33-weeks received respiratory support vs. 46, 39 and 7% born at 34-, 35- and 36-weeks, respectively (P < 0.001). Multiple births, BW within a given PMA, SGA status, respiratory support, RDS, delayed gavage-free feeds and birthplace were associated with longer than Median LOS at each PMA (P ≤ 0.04). Achievement of gavage-free feeding was consistently the main determinant of early discharge home across all PMAs (P < 0.001).
Conclusions:
Our newer approach in identifying relationship among morbidities in infant born at 33-36 weeks PMA fills important knowledge gaps. These data will facilitate evidence-based clinical care, educational-needs, health care resource planning and parental counseling.
Impact:
Either grouped and/or fragmented data are available for morbidities in infants born between 33 and 36 weeks post-menstrual age (PMA), which represents >80% of all preterm infants. We demonstrate that respiratory insufficiency, type of respiratory support, delayed gavage-free feedings and length of stay (LOS) are inter-dependent and PMA-specific. Using a novel approach, we provide new significant data that identify clinical variables, associated with shorter and longer than Median LOS at each and even within a given PMA. Comprehensive analysis of morbidities suggests that preterm infants should neither be grouped, nor PMA alone be used for discharge planning and parental counseling.
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