Clinical and Maternal Factors Predicting Length of Stay in Very Low Birth Weight Neonates: A Prospective Cross-Sectional Study from a Tertiary Care Center in Western India
DOI:
https://doi.org/10.63682/jns.v14i20S.5055Keywords:
Very low birth weight, Length of stay, NICU, Predictors, Sepsis, Respiratory distress syndrome, Feeding progression, Gestational ageAbstract
Background: Very low birth weight (VLBW) infants require specialized neonatal intensive care, resulting in prolonged hospitalization and increased healthcare costs. Understanding factors that predict length of stay (LOS) is crucial for resource planning and family counseling.
Objective: To determine factors predicting length of stay in VLBW neonates in an urban tertiary care center in Western India.
Methods: This prospective cross-sectional study enrolled 58 VLBW neonates (1000-1500g) admitted to a tertiary care NICU over an 18-month period. Maternal factors, neonatal characteristics, morbidities, and interventions were recorded. Length of stay and post-discharge outcomes were analyzed. Parametric data were evaluated using linear correlation, while non-parametric data were analyzed using Mann-Whitney U and Kruskal-Wallis tests.
Results: Mean gestational age was 31.2±2.0 weeks and mean birth weight was 1284.2±137.8g. Mean LOS was 38.0±16.0 days (range: 9-73 days). Gestational age (r=-0.635, p<0.0001) and birth weight (r=-0.558, p<0.0001) showed strong negative correlations with LOS. Clinical sepsis (41.7±15.2 vs 22.2±7.8 days, p<0.0001), respiratory distress syndrome (44.7±14.8 vs 27.1±11.4 days, p<0.0001), apnea (43.3±14.5 vs 33.1±16.0 days, p=0.014), and intraventricular hemorrhage (73.0 vs 37.4±15.4 days, p=0.026) were associated with significantly longer LOS. Small for gestational age neonates had shorter LOS compared to appropriate-for-gestational-age counterparts (31.5±14.3 vs 40.7±16.1 days, p=0.046). Days to achieve full enteral feeding strongly correlated with LOS (r=0.604, p<0.0001). The overall mortality rate was 6.9% and readmission rate was 1.7%.
Conclusion: Gestational age, birth weight, presence of sepsis, respiratory morbidities, and time to full enteral feeding were the strongest predictors of NICU length of stay in VLBW neonates. These findings can guide resource allocation, parental counseling, and development of interventions targeting modifiable factors to potentially reduce hospitalization duration without compromising outcomes
Downloads
Metrics
References
World Health Organization. International statistical classification of diseases and related health problems, 10th revision. 2nd ed. Geneva: WHO; 2004.
World Health Organization. WHO estimates that globally about 25 million low birth weight babies are born each year. Geneva: WHO; 2019.
Kabilan S, Kumar MS. Morbidity and mortality pattern of very low birth weight infants admitted in SNCU in a South Asian tertiary care centre. Int J Contemp Pediatr. 2018;5(3):720-724.
Nayeri F, Emami Z, Mohammadzadeh Y, Shariat M, Sagheb S, Sahebi L. Mortality and Morbidity Patterns of Very Low Birth Weight Newborns in Eastern Mediterranean Region: A Meta-Analysis Study. Journal of Pediatrics Review. 2019;7(2):67-76.
Ballot DE, Chirwa TF, Cooper PA. Determinants of survival in very low birth weight neonates in a public sector hospital in Johannesburg. BMC Pediatrics. 2010;10(1):30.
Horbar JD, Carpenter JH, Badger GJ, Kenny MJ, Soll RF, Morrow KA, Buzas JS. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics. 2012;129(6):1019-26.
Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA. 2015;314(10):1039-51.
Vohr BR, Wright LL, Dusick AM, Mele L, Verter J, Steichen JJ, et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. Pediatrics. 2000;105(6):1216-26.
Schulman J. Studying determinants of length of hospital stay. Journal of Perinatology. 2006;26(4):243-5.
Pizzolorusso G, Turi P, Barlafante G, Cerritelli F, Renzetti C, Cozzolino V, et al. Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory study. Chiropractic & Manual Therapies. 2011;19(1):1-6.
Parker LA, Neu J, Torrazza RM, Li Y. Scientifically based strategies for enteral feeding in premature infants. NeoReviews. 2013;14(7):e350-9.
Powell PJ, Powell CV, Hollis S, Robinson MJ. When will my baby go home?. Archives of Disease in Childhood. 1992;67(10):1214-6.
Pizzolorusso G, Turi P, Barlafante G, Cerritelli F, Renzetti C, Cozzolino V, et al. Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory study. Chiropractic & Manual Therapies. 2011;19(1):1-6.
Klinger G, Sirota L, Lusky A, Reichman B. Bronchopulmonary dysplasia in very low birth weight infants is associated with prolonged hospital stay. Journal of Perinatology. 2006;26(10):640-4.
Hintz SR, Bann CM, Ambalavanan N, Cotten CM, Das A, Higgins RD. Predicting time to hospital discharge for extremely preterm infants. Pediatrics. 2010;125(1):e146-54.
American Academy of Pediatrics Committee on Fetus and Newborn. Levels of neonatal care. Pediatrics. 2012;130(3):587-97.
Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. The Journal of Pediatrics. 1991;119(3):417-23.
Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European consensus guidelines on the management of respiratory distress syndrome - 2019 update. Neonatology. 2019;115(4):432-50.
National Neonatology Forum of India. Evidence Based Clinical Practice Guidelines. New Delhi: NNF India; 2010.
Bender GJ, Koestler D, Ombao H, McCourt M, Alskinis B, Rubin LP, Padbury JF. Neonatal intensive care unit: predictive models for length of stay. Journal of Perinatology. 2013;33(2):147-53.
Lee HC, Bennett MV, Schulman J, Gould JB. Accounting for variation in length of NICU stay for extremely low birth weight infants. Journal of Perinatology. 2013;33(11):872-6.
Sheikh L, O'brien M, McCluskey-Fawcett K. Birth through 1 year: Handbook of infant development. Oxford, England: John Wiley & Sons; 1993.
Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics. 2008;122(5):1119-26.
Lee HC, Bennett MV, Schulman J, Gould JB. Accounting for variation in length of NICU stay for extremely low birth weight infants. Journal of Perinatology. 2013;33(11):872-6.
Korvenranta E, Linna M, Häkkinen U, Peltola M, Andersson S, Gissler M, et al. Differences in the length of initial hospital stay in very preterm infants. Acta Paediatrica. 2007;96(10):1416-20.
Ballot DE, Chirwa TF, Cooper PA. Determinants of survival in very low birth weight neonates in a public sector hospital in Johannesburg. BMC Pediatrics. 2010;10(1):30.
Zeitlin J, El Ayoubi M, Jarreau PH, Draper ES, Blondel B, Künzel W, et al. Impact of fetal growth restriction on mortality and morbidity in a very preterm birth cohort. The Journal of Pediatrics. 2010;157(5):733-9.
Kent AL, Wright IM, Abdel-Latif ME. Mortality and adverse neurologic outcomes are greater in preterm male infants. Pediatrics. 2012;129(1):124-31.
Berry MA, Shah PS, Brouillette RT, Hellmann J. Predictors of mortality and length of stay for neonates admitted to children's hospital neonatal intensive care units. Journal of Perinatology. 2008;28(4):297-302.
Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: A large, population-based study. Diabetes Care. 2009;32(11):2005-9.
Dani C, Reali MF, Bertini G, Wiechmann L, Spagnolo A, Tangucci M, et al. Risk factors for the development of respiratory distress syndrome and transient tachypnoea in newborn infants. European Respiratory Journal. 1999;14(1):155-9.
Afrasiabi N, Mohagheghi P, Kalani M, Mohades G, Farahani Z. The effect of high risk pregnancy on duration of neonatal stay in neonatal intensive care unit. Iranian Journal of Pediatrics. 2014;24(4):423-8.
Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002;110(2):285-91.
Payne NR, Carpenter JH, Badger GJ, Horbar JD, Rogowski J. Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants. Pediatrics. 2004;114(2):348-55.
Cotton CM, Oh W, McDonald S, Carlo W, Fanaroff AA, Duara S, et al. Prolonged hospital stay for extremely premature infants: risk factors, center differences, and the impact of mortality on selecting a best-performing center. Journal of Perinatology. 2005;25(10):650-5.
Eichenwald EC, Committee on Fetus and Newborn. Apnea of prematurity. Pediatrics. 2016;137(1):e20153757.
Eichenwald EC, Blackwell M, Lloyd JS, Tran T, Wilker RE, Richardson DK. Inter-neonatal intensive care unit variation in discharge timing: influence of apnea and feeding management. Pediatrics. 2001;108(4):928-33.
Bisquera JA, Cooper TR, Berseth CL. Impact of necrotizing enterocolitis on length of stay and hospital charges in very low birth weight infants. Pediatrics. 2002;109(3):423-8.
Edwards L, Cotten CM, Smith PB, Goldberg R, Saha S, Das A, et al. Inadequate oral feeding as a barrier to discharge in moderately preterm infants. Journal of Perinatology. 2019;39(9):1219-28.
Lau C. Oral feeding in the preterm infant. NeoReviews. 2006;7(1):e19-e27.
Mizuno K, Ueda A. Neonatal feeding performance as a predictor of neurodevelopmental outcome at 18 months. Developmental Medicine & Child Neurology. 2005;47(5):299-304.
Soni A, Kadam S, Pandit A, Patole S. Early discharge of preterm infants - An Indian perspective. Journal of Clinical and Diagnostic Research. 2016;10(12):SC21-SC26.
Underwood MA, Danielsen B, Gilbert WM. Cost, causes and rates of rehospitalization of preterm infants. Journal of Perinatology. 2007;27(10):614-9.
Tseng YH, Chen CW, Huang HL, Chen CC, Lee MD, Ko MC, Li CY. Incidence of and predictors for short-term readmission among preterm low birth weight infants. Pediatrics International. 2010;52(5):711-7.
Melnyk BM, Feinstein NF, Alpert-Gillis L, Fairbanks E, Crean HF, Sinkin RA, et al. Reducing premature infants' length of stay and improving parents' mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial. Pediatrics. 2006;118(5):e1414-27.
Merritt TA, Pillers D, Prows SL. Early NICU discharge of very low birth weight infants: a critical review and analysis. Seminars in Neonatology. 2003;8(2):95-115.
Lessen BS. Effect of the premature infant oral motor intervention on feeding progression and length of stay in preterm infants. Advances in Neonatal Care. 2011;11(2):129-39.
Benevente-Fernández I, Redondo MD, Castellanos JL, Muñuzuri AP, Gracia SR, Campillo CW, et al. Hospital discharge criteria for very low birth weight newborns. Anales de Pediatría (English Edition). 2017;87(1):54.e1-54.e8.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
