Variations in Neonatal Length of Stay of Babies Born Extremely Preterm: An International Comparison Between iNeo Networks.

Affiliation

Collaborators: Lui K, Marshall P, Schmidt P, Dhawan A, Korostenski L, Travadi JT, Sharp M, Gill A, Pillow J, Stack J, Birch P, Nothdurft K, Cooke L, Casalaz D, Holberton J, Stewart A, Downe L, Stewart M, Berry A, Hunt R, Morris P, Paoli T, Lui K, Bolisetty S, Paradisis M, Greenhalgh M, Koorts P, Kuschel C, Jacobs S, Doyle L, Craven J, Numa A, Carlisle H, Badawi N, Popat H, Koh G, Davis J, Luig M, Headley B, Andersen C, Ng L, Chambers G, Austin N, Lynn A, Darlow B, Edmonds L, Mildenhall L, Buksh M, Battin M, Boom JVD, Richardson V, Barker D, Hammond B, Rajadurai VS, Lam S, Fung G, Shah PS, Beltempo M, Kanungo J, Ting J, Cieslak Z, Sherlock R, Mehrem AA, Toye J, Aziz K, Fajardo C, Bodani J, Strueby L, Seshia M, Louis D, Alvaro R, Mukerji A, Da Silva O, Adie M, Lee KS, Ng E, Lemyre B, Daboval T, Khurshid F, Pelausa E, Barrington K, Lapoint A, Ethier G, Drolet C, Piedboeuf B, Claveau M, St-Hilaire M, Bertelle V, Masse E, Canning R, Makary H, Ojah C, Monterrosa L, Emberley J, Afifi J, Kajetanowicz A, Lee SK, Metsäranta M, Lehtonen L, Tammela O, Sankilampi U, Saarela T, Morag I, Zangen S, Smolkin T, Mimouni F, Bader D, Rothschild A, Strauss Z, Felszer C, Omari H, Tov-Friedman SE, Bar-Oz B, Feldman M, Saad N, Flidel-Rimon O, Weisbrod M, Lubin D, Litmanovitz I, Kugelman A, Shinwell E, Klinger G, Nijim Y, Bin-Nun A, Golan A, Mandel D, Fleisher-Sheffer V, Oron A, Bakhrakh L, Hattori S, Shirai M, Ishioka T, Mori T, Amizuka T, Huchimukai T, Yoshida H, Sasaki A, Shimizu J, Nakamura T, Maruyama M, Matsumoto H, Hosokawa S, Taki A, Nakagawa M, Ko K, Uozumi A, Nakata S, Shimazaki A, Yoda T, Numata O, Imamura H, Kobayashi A, Tokuriki S, Uchida Y, Arai T, Ito M, Ieda K, Ono T, Hayashi M, Maki K, Yamakawa M, Kawai M, Fujii N, Shiomi K, Nozaki K, Wada H, Kim T, Tokunaga Y, Tokunaga Y, Takatera A, Oshima T, Sumida H, Michinomae Y, Kusumoto Y, Yoshimoto S, Morisawa T, Ohashi T, Takahashi Y, Sugimoto M, Ono N, Miyagawa S, Saijo T, Yamagami T, Koyano K, Kobayashi S, Kanda T, Sakemi Y, Aoki M, Iida K, Goshi M, Maruyama Y, Avila-Alvarez A, Fernandez-Trisac JL, Pico MLC, Fernández Seara MJ, Gutiérrez AM, Vizcaíno C, Iglesias MS, Zaplana HS, Colomer BF, García López JE, Mozo RG, González Martínez MT, Sebastián MDM, Carbonell MB, Barnusell JB, Puiggròs MD, Aloy JF, Mussons FB, Sanz IA, Galiana GG, Coroleu W, Iriondo M, Vilella LC, Porta R, Demestre X, Nadal SM, de Frutos Martínez C, López Cuesta MJ, Mora DE, Tardío JO, Benavente I, Alonso A, Olmos RA, García Cabezas MA, Jiménez MDM, Caballero MPJ, Díaz MDO, Fagundo AT, Canals LM, García-Muñoz Rodrigo F, Martí LU, Moreno Galdo MF, Suazo JAH, López EN, Fernández JU, Cortajarena Altuna MA, Zuriarrain OM, Navarro DM, Domínguez MT, Ruiz Del Prado MY, Díez IE, Palau Benavides MT, Lapeña S, Prada T, Mir ES, Sánchez AC, Vega EC, Prado ND, Fernández C, Vilaplana LC, Pérez IC, Gómez LL, Comeche LD, Martín IL, Armengod CG, Labián CM, Muñoz MJS, Bravo DB, Pérez V, Fernández MDE, González CD, Segura SA, Azorín ML, Jimenez AB, Sánchez-Tamayo T, Moreno ET, González M, Sánchez Martínez JE, Lloreda García JM, Orayen CG, González JV, Albo MS, Colmenero EG, Gutiérrez González EP, Vacas Del Arco B, Fernández JM, Gordillo LA, Asensio MG, Díaz CM, Albújar M, Jorge PF, Romero S, Falero MR, Escobar Izquierdo AB, Capell JE, Macián MII, Vicente MMM, Caballero RI, Martínez MM, Euba A, Serna AR, López de Heredia Goya JM, Legorburu AP, Amorós AG, Marugán Isabel VM, González NH, Gracia SR, Faci MPV, Villagrasa MPS, Kofron J, Brodd KS, Odlind A, Alberg L, Arwehed S, Hafström O, Kasemo A, Nederman K, Åhman L, Ingemarsson F, Petersson H, Thurn P, Albinsson E, Selander B, Abrahamsson T, Heimdahl I, Sveinsdottir K, Wejryd E, Hedlund A, Söderberg MK, Navér L, Brune T, Bäckström J, Robinson J, Farooqi A, Normann E, Fredriksson M, Palm A, Rosenqvist U, Walde B, Hagman C, Ohlin A, Florell R, Smedsaas-Löfvenberg A, Adams M, Meyer P, Kusche R, Schulzke S, Nelle M, Wagner B, Riedel T, Kaczala G, Pfister RE, Tolsa JF, Roth M, Stocker M, Laubscher B, Malzacher A, Micallef JP, Hegi L, Bassler D, Arlettaz R, Bernet V, Dani C, Fiorini P, Ghirri P, Tomasini B, Mittal A, Kefas J, Kamalanathan A, Grosdenier M, Dewhurst C, Bontea A, Webb D, Garr R, Hassan A, Ambadkar P, Dyke M, McDevitt K, Rewitzky G, D'Amore A, Kamath P, Settle P, Maddock N, Edi-Osagie N, Zipitis C, Heal C, Birch J, Hasib A, Soe A, Abdul-Malik B, Kisat H, Vasu V, Sivashankar S, Gupta R, Rawlingson C, Wickham T, Theron M, Kendall G, Gupta A, Aladangady N, Ali I, Jain N, Mannan K, Murthy V, Sullivan C, Chuang SL, Bate T, Tyszcuzk L, Tyszcuzk L, Lee G, Obi O, Chang J, Pai V, Huddy C, Yasin S, Nicholl R, Pandey P, Cusack J, Kairamkonda V, Muogbo D, Harry L, Surana P, Broggio P, Surana P, Harry L, Pillay T, Deshpande S, Mahadevan, Moore A, Bastani P, Garbash M, Lal M, Abu-Harb M, Garbash M, Allwood A, Selter M, Munyard P, Bartle D, Paul S, Whincup G, Rekha S, Amess P, Obi B, Amess P, Reynolds P, Misra I, De Halpert P, Salgia S, Sanghavi R, Paul N, Deketelaere A, Khashu M, Johnson M, Groves C, Baird J, Brennan N, Vamvakiti K, McIntyre J, Holman J, Jones S, Pike A, Cairns P, Eaton M, Schwarz K, Gibson D, Miall L, Gibson D, Krishnamurthy D, Narayanan S.
Author information:
(1)Department of Health Sciences, University of Leicester, Leicester, United Kingdom. Electronic address: [Email]
(2)Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
(3)Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
(4)Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan.
(5)Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden.
(6)Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.
(7)Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Ramat Gan, Israel.
(8)Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.
(9)Division of Neonatology and Health Research Institute La Fe, Valencia, Spain.
(10)Department of Paediatrics, University of Otago, Christchurch, New Zealand.
(11)Unit of Epidemiology, Anna Meyer Children's Hospital, Florence, Italy.
(12)McGill University, Montreal, Quebec, Canada.
(13)Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
(14)School of Women's and Children's Health, University of New South Wales, Australia.
(15)Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden.
(16)UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom.

Abstract

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.