774 - Impact of neonatal comorbidities and medical technology on extended lengths of stay in extremely premature infants

Publication Number: 2755.774

Danica Mathew, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Camille Fonseca, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Danielle LoRe, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Hackensack, NJ, United States; Patrick Myers, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Theiju Sebastian, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, Hinsdale, IL, United States; Arnab Sengupta, ProMedica Toledo Children's Hospital, Sylvania, OH, United States; Bree Andrews, The University if Chicago, Chicago, IL, United States

Background: Extremely premature infants often experience prolonged hospitalizations due to multiple comorbidities and complex care needs, increasing healthcare burden and impacting family bonding. Understanding discharge timing may help clinicians and families plan for hospitalizations and transitions home.

Objective: To determine if comorbidities and medical technology needs at discharge increase the odds of discharge at corrected gestational age (cGA) >44 weeks, beyond the effect of gestational age alone in infants born between 22- and 24-weeks' gestation.

Design/Methods: This multicenter, retrospective cohort study analyzed 599 neonates from a total of 1505 from 6 tertiary care centers in the Vermont Oxford Network, born between 2012-2020 at 22 0/7 and 24 6/7 weeks' GA. Infants included survived to hospital discharge. The primary outcome was discharge after cGA >44 weeks. Discharge after cGA >48 weeks and >52 weeks was also examined. Neonatal comorbidities and technology-dependence were tested in univariate analysis using logistic regression. A multivariable logistic regression model was then used to evaluate the independent effect of significant factors using backward selection. A p-value < 0.05 was considered statistically significant, and data were analyzed using Stata.

Results: Among infants that survived to discharge, 68.8% were born at 24 weeks', 28.0% at 23 weeks', and 3.2% at 22 weeks' GA (Table 1). Of the total cohort, 56.6% was discharged before 44 weeks cGA (Figure 1). Infants of 22-weeks' GA represent 6.7% of infants hospitalized beyond 52 weeks cGA. Multivariate analysis showed higher odds of discharge at cGA >44 weeks with need for gastrostomy/jejunostomy tube [OR 24.2 (CI 9.4-62.5), p < 0.001], necrotizing enterocolitis (NEC) [OR 2.6 (CI 1.5-4.5), p < 0.001], ventriculoperitoneal shunt [OR 3.2 (CI 1.4-7.0), p=0.004, chronic lung disease (CLD) [OR 2.1 (CI 1.2-3.6), p =0.007], oxygen at discharge [OR 1.8 (CI 1.1-2.8), p=0.015], and tracheostomy [OR 10.0 (CI 1.1-90.7), p=0.04] (Table 2). There was a trend towards lower odds of discharge at cGA >44 weeks as birth weight increased [OR 0.998, (CI 0.996-1.0, p 0.066].

Conclusion(s): More than half of infants born at 22-24 weeks' GA are discharged < 44 weeks cGA. There is a small contribution of 22-weeks' GA infants to overall survival and resource utilization, representing only 6.7% of infants hospitalized beyond 52 weeks' cGA. CLD, NEC, and need for medical technologies drive prolonged LOS more significantly than GA alone. These findings provide a framework for clinicians to counsel families regarding expected NICU course and optimize resource planning.

Study demographics based on gestational age
Study demographics based on gestational age

Discharge timing by on gestational age
Discharge timing by on gestational age

Results of univariate and multivariate analysis for study variables
Results of univariate and multivariate analysis for study variables