718 - Major Morbidity Diagnoses in Neonates Born Between 22- and 24-Weeks’ Gestation Have Significant Impacts on Length of Stay

Publication Number: 718.5928

Camille Fonseca, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Jillian E. Bowman, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, Chicago, IL, United States; Cameron N.. Boyd, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Kathleen Brennan, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Catherine M. Groden, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, Chicago, IL, United States; Danielle LoRe, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Samantha Millikan, Vanderbilt University Medical Center, Nashville, TN, United States; Patrick Myers, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Lorena Ostilla, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Allison Schuh, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Theiju Sebastian, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, Hinsdale, IL, United States; Bree Andrews, University of Chicago, Chicago, IL, United States

Background: There is variation in resuscitation practices for newborns delivered between 22 0/7 and 24 6/7 weeks’ gestation due to high risks of morbidity and mortality. Little is known about how major morbidities in this population impact resource utilization during neonatal ICU stays.

Objective: To study how common comorbidities in gestational ages (GA) 22-24 weeks, including chronic lung disease (CLD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and late-stage infection, affect length of stay (LOS).

Design/Methods: This multicenter, retrospective cohort study evaluated 755 infants born at GA between 22- and 24-weeks who survived to discharge, transfer, or were in the hospital at 1 year of life out of a total of 1505 infants born between 2011 and 2020 at 6 pediatric tertiary care hospitals. Median LOS for each GA group with and without each comorbidity was calculated. Data was further analyzed with Kruskal-Wallis tests and Nemenyi tests for post-hoc comparisons.

Results: In patients with CLD, there was a significant difference in LOS between GA of 23-weeks and 24-weeks (p < 0.001). Infants born at 23-weeks with CLD had significantly increased LOS compared to those without (p < 0.001), as did 24-week infants with CLD vs. those without (p < 0.001). There was no significant difference in LOS in infants with NEC vs. those without at GA of 22- and 23-weeks (p=0.164, p=0.059), but a significant difference was found in LOS for 24-week infants (p < 0.001). Similarly, there were no significant differences in LOS for infants with IVH at 22- and 23-weeks (p=0.092, p=0.438), but there was a significant difference at 24-weeks’ GA (p < 0.001). Only one infant born at 22-weeks did not have ROP, so no comparisons were made for this GA. ROP made a significant difference in LOS for infants born at 24-weeks (p < 0.001). The presence of late-stage infection made a significant difference in LOS for 23- and 24-week infants when compared to those without infection (p < 0.001).

Conclusion(s): The presence of common comorbidities did not uniformly increase length of stay for neonates in the sample. For many of the comorbidities, infants of 23- and 24-weeks’ GA were more likely to have significantly increased LOS than infants of 22 weeks’ GA. Understanding resource use based on the presence of major comorbidities may lead to better insights into extremely premature infant hospital trajectories.

Demographic data of study group


Length of stay comparison by major comorbidity diagnosis at time of discharge
*N/A = comparison not possible due to singular data point

Length of stay by major comorbidity at time of discharge