Clinical characteristics and outcomes of infants requiring long-term neonatal intensive care

This study seeks to better describe the characteristics and outcomes of infants who stay for prolonged periods in the neonatal intensive care unit (NICU). Of 1174 consecutive admissions to a NICU, 73 (6%) met criteria for long-term neonatal intensive care (LTNIC). NICU care totaled 24,631 days; LTNIC infants needed 9152 days (37%). Average NICU stay for LTNIC infants was 125 days (SD +/- 102 days), compared with 14 days +/- 17 days for non-LTNIC infants. The LTNIC infants < or = 1500 gm accounted for 22% of the NICU days of care. There were no differences in gestational age, birth weight, gender, or race between LTNIC and non-LTNIC infants. Survival at discharge was not different, although when neonatal deaths (< or = 28 days) were excluded, the survival of LTNIC infants was significantly less (p < 0.0001). Of 56 LTNIC infants who survived to NICU discharge, 11 (three < or = 1500 gm) subsequently died before 2 years of age, and 10 (six < or = 1500 gm) were probably developmentally delayed. Infants with the longest NICU stays often have multiple medical and surgical problems and unfavorable outcomes, and they consume a disproportionately large percentage of NICU resources. Efforts to contain NICU costs, increase NICU bed availability, and improve NICU outcomes should not ignore infants who require prolonged NICU stays.