457 - Determinants of Length of Stay for Late Preterm Infants

Poster Number: 457
Publication Number: 457.130

Raj K. Jayanthan, Cohen Children's Medical Center, LONG ISLAND CITY, NY, United States; Jane Cerise, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States; Barry Weinberger, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States

Background: Late preterm infants (LPIs) comprise > 65% of preterm births, accounting for significant NICU utilization. Our practice is to admit 34-week infants to NICU and to evaluate 35-week infants for > 6 hours in NICU. However, NICU length-of-stay (LOS) for LPIs is extremely variable based on the presence and severity of morbidities related to maturity. Requirements for discharge include stable respiration on room air without apnea, normothermia, normoglycemia, and achievement of > 100-140 mL/kg/day of oral feeds. Shortening NICU LOS is an important QI goal because it can improve lactation and bonding, as well as decrease healthcare costs. However, the specific determinants of LOS for LPIs are not known.

Objective: Our objective was to identify which distinct medical or maturational requirements most affect NICU LOS for well 34- and 35-week LPIs, defined as shortest time from resolution until discharge.

Design/Methods: We conducted a retrospective chart review of inborn infants (n=105) born at 34 and 35 weeks gestation without genetic, anatomic, or infectious diagnoses and discharged from NICU to home. The onset and duration of the following interventions or events were recorded: 1) positive airway pressure or nasal cannula, 2) thermal support, 3) oral or intravenous dextrose, 4) phototherapy, 5) apnea, bradycardia, desaturations, 6) intravenous fluids, 7) nasogastric feeds, 8) achievement of 100 and 140 mL/kg/day oral feeds. The time (in days) from resolution of each intervention or event until discharge was calculated.

Results: The median LOS was 8 (IQR 7-11) days. Interventions and events included positive airway pressure (59.0%), cannula (2.9%), apnea (15.2%), bradycardia (18.1%), desaturations (29.5%), thermal support (100%), phototherapy (39.0%), hypoglycemia (47.6%), intravenous fluids (68.6%), and nasogastric feeds (34.3%). Of the 105 infants, 74 had one event resolve closest to discharge. For 31 infants, 2-3 events resolved on the same day closest to discharge. Reaching oral feeds of 140 mL/kg/day (55.2%), end of thermal support (33.3%), and reaching oral feeds of 100 mL/kg/day (19.0%) were the achievements closest to discharge, both among all infants and among those with a single resolution closest to discharge.Conclusion(s): Late preterm 34- and 35-week infants often have significant medical and developmental needs requiring NICU care. Our findings suggest that the efficacy of oral feeding is most likely to affect NICU LOS, followed by thermoregulation. Earlier oral stimulation and feeding advancement may help shorten LOS for these infants.