547 - Determining the Barriers to Discharge in Preterm Infants Born at 33 and 34 Weeks Gestation

Publication Number: 547.4077

Ivana J. Yoon, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States; Lauren Muraoka, University of Hawaii, John A. Burns School of Medicine, Mililani, HI, United States; Kevin Pham, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Pattaraporn T. Chun, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States; Lynn M. Iwamoto, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States

Background: From 2005-2018, length of stay (LOS) for preterm infants in the US increased an average of 8 days across all gestations. This suggests increased complexity in overall care, resulting in a significant burden on healthcare resources and costs. LOS for late preterm infants at Kapi’olani Medical Center for Women and Children (KMCWC) NICU also increased from 2012-2021. Preliminary analysis suggested infants born in 2021 may have experienced a greater degree of prenatal stress. Postnatally, 2021 infants required more positive-pressure support, tube feeding, parenteral nutrition, and longer incubator support.

Objective: This study aims to identify intrinsic infant maturity factors and practice changes associated with increased NICU LOS in late preterm infants over a 9 year period between 2012-2021.

Design/Methods: This retrospective chart review compared four cohorts of preterm infants born at 33 and 34 weeks GA, admitted to KMCWC NICU in 2012, 2015, 2018, and 2021. Those with major congenital anomalies, expired before discharge, or transferred to another facility were excluded. Demographic data, maternal risk factors, and comorbidities were collected. Cohorts within each GA group were compared using t-test for continuous variables and chi-square analysis for categorical data.

Results: Over 4 time periods from 2012-2021, LOS increased by approximately 4 days for both GA cohorts. There were no significant differences in gender distribution or birth weight, though average discharge weight increased. More 33w (Table 1) and 34w GA (Table 2) infants received parenteral nutrition for longer duration after 2012, and more required supplemental tube feeding.

Caloric density requirements significantly increased after 2012. Additionally, more infants required positive pressure support and incubator care for both cohorts. The significant differences for these factors were predominantly between 2012 and 2015 compared to the later time periods.

Concomitant with increase in LOS, rate of emergency department (ED) visit or readmission from 2012 to 2021 decreased for 34w GA infants, but not for 33w.

Conclusion(s): Common trends were associated with increased LOS for 33w and 34w GA infants; with the largest differences observed between 2012 and 2015, possibly reflecting management changes. This was balanced by decreased ED visits and readmissions but only in 34w GA infants. After 2012, more infants required respiratory, thermal, nutritional and feeding support, correlating with median LOS. Therefore, targeted improvements in feeding practices and supportive care may reduce LOS.

Table 1. 33-week GA cohort
*Mean ± SD
1Different from 2012, p<0.05

Table 2. 34-week GA cohort
*Mean ± SD
1Different from 2012, p<0.05

Table 1. 33-week GA cohort
*Mean ± SD
1Different from 2012, p<0.05

Table 2. 34-week GA cohort
*Mean ± SD
1Different from 2012, p<0.05