TY - JOUR
T1 - Variations in Neonatal Length of Stay of Babies Born Extremely Preterm
T2 - An International Comparison Between iNeo Networks
AU - UK Neonatal Collaborative
AU - International Network for Evaluating Outcomes of Neonates (iNeo) Investigators
AU - ANZNN (Australian and New Zealand Neonatal Network)
AU - CNN (Canadian Neonatal Network)
AU - NRNJ (Neonatal Research Network Japan)
AU - SEN1500 (Spanish Neonatal Network)
AU - SwissNeoNet (Swiss Neonatal Network)
AU - FinMBR (Finnish Medical Birth Register)
AU - INN (Israel Neonatal Network)
AU - SNQ (Swedish Neonatal Quality Register)
AU - TIN Toscane online (Tuscany Neonatal Network)
AU - UKNC (United Kingdom Neonatal Collaborative)
AU - Seaton, Sarah E.
AU - Draper, Elizabeth S.
AU - Adams, Mark
AU - Kusuda, Satoshi
AU - Håkansson, Stellan
AU - Helenius, Kjell
AU - Reichman, Brian
AU - Lehtonen, Liisa
AU - Bassler, Dirk
AU - Lee, Shoo K.
AU - Vento, Maximo
AU - Darlow, Brian A.
AU - Rusconi, Franca
AU - Beltempo, Marc
AU - Isayama, Tetsuya
AU - Lui, Kei
AU - Norman, Mikael
AU - Yang, Junmin
AU - Shah, Prakesh S.
AU - Modi, Neena
AU - Marshall, Peter
AU - Schmidt, Peter
AU - Dhawan, Anjali
AU - Korostenski, Larissa
AU - Travadi, Javeed Travadi
AU - Sharp, Mary
AU - Gill, Andy
AU - Pillow, Jane
AU - Stack, Jacqueline
AU - Birch, Pita
AU - Nothdurft, Karen
AU - Cooke, Lucy
AU - Casalaz, Dan
AU - Holberton, Jim
AU - Stewart, Alice
AU - Downe, Lyn
AU - Stewart, Michael
AU - Berry, Andrew
AU - Hunt, Rod
AU - Morris, Peter
AU - Paoli, Tony De
AU - Bolisetty, Srinivas
AU - Paradisis, Mary
AU - Greenhalgh, Mark
AU - Koorts, Pieter
AU - Kuschel, Carl
AU - Jacobs, Sue
AU - Doyle, Lex
AU - Craven, John
AU - Afifi, Jehier
N1 - Funding Information:
The authors gratefully acknowledge the diligent work of the site investigators and data abstractors from the networks participating in the iNeo consortium and this study. We thank Heather McDonald-Kinkaid, PhD, from the Maternal-infant Care Research Centre (MiCare) in Toronto, Ontario, Canada, for editorial assistance in the preparation of this manuscript. Funding and disclosure statements available atwww.jpeds.com.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/6
Y1 - 2021/6
N2 - Objective: To compare length of stay (LOS) in neonatal care for babies born extremely preterm admitted to networks participating in the International Network for Evaluating Outcomes of Neonates (iNeo). Study design: Data were extracted for babies admitted from 2014 to 2016 and born at 24 to 28 weeks of gestational age (n = 28 204). Median LOS was calculated for each network for babies who survived and those who died while in neonatal care. A linear regression model was used to investigate differences in LOS between networks after adjusting for gestational age, birth weight z score, sex, and multiplicity. A sensitivity analysis was conducted for babies who were discharged home directly. Results: Observed median LOS for babies who survived was longest in Japan (107 days); this result persisted after adjustment (20.7 days more than reference, 95% CI 19.3-22.1). Finland had the shortest adjusted LOS (−4.8 days less than reference, 95% CI –7.3 to −2.3). For each week's increase in gestational age at birth, LOS decreased by 12.1 days (95% CI –12.3 to −11.9). Multiplicity and male sex predicted mean increases in LOS of 2.6 (95% CI 2.0-3.2) and 2.1 (95% CI 1.6-2.6) days, respectively. Conclusions: We identified between-network differences in LOS of up to 3 weeks for babies born extremely preterm. Some of these may be partly explained by differences in mortality, but unexplained variations also may be related to differences in clinical care practices and healthcare systems between countries.
AB - Objective: To compare length of stay (LOS) in neonatal care for babies born extremely preterm admitted to networks participating in the International Network for Evaluating Outcomes of Neonates (iNeo). Study design: Data were extracted for babies admitted from 2014 to 2016 and born at 24 to 28 weeks of gestational age (n = 28 204). Median LOS was calculated for each network for babies who survived and those who died while in neonatal care. A linear regression model was used to investigate differences in LOS between networks after adjusting for gestational age, birth weight z score, sex, and multiplicity. A sensitivity analysis was conducted for babies who were discharged home directly. Results: Observed median LOS for babies who survived was longest in Japan (107 days); this result persisted after adjustment (20.7 days more than reference, 95% CI 19.3-22.1). Finland had the shortest adjusted LOS (−4.8 days less than reference, 95% CI –7.3 to −2.3). For each week's increase in gestational age at birth, LOS decreased by 12.1 days (95% CI –12.3 to −11.9). Multiplicity and male sex predicted mean increases in LOS of 2.6 (95% CI 2.0-3.2) and 2.1 (95% CI 1.6-2.6) days, respectively. Conclusions: We identified between-network differences in LOS of up to 3 weeks for babies born extremely preterm. Some of these may be partly explained by differences in mortality, but unexplained variations also may be related to differences in clinical care practices and healthcare systems between countries.
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U2 - 10.1016/j.jpeds.2021.02.015
DO - 10.1016/j.jpeds.2021.02.015
M3 - Article
C2 - 33600820
AN - SCOPUS:85103574386
SN - 0022-3476
VL - 233
SP - 26-32.e6
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -