735 - Technology Use at Discharge has Significant Impacts on Length of Stay for Extremely Premature Infants

Publication Number: 735.6874

Bree Andrews, University of Chicago, Chicago, IL, United States; Theiju Sebastian, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, Hinsdale, IL, United States; Jillian E. Bowman, 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; 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; Camille Fonseca, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Cameron N.. Boyd, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States

Background: There is considerable 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 these morbidities, particularly those that necessitate medical technology at discharge, impact resource utilization during neonatal ICU stays.

Objective: To explore length of stay (LOS) differences in patients with gestational ages (GA) of 22-, 23-and 24-weeks in relation to their medical technology needs at discharge.

Design/Methods: This multicenter, retrospective cohort study evaluated 755 infants born between 22- and 24-weeks GA who survived to discharge, transfer, or were in the hospital at 1 year of life from 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 analyzed with Kruskal-Wallis tests and Nemenyi tests for post-hoc comparisons.

Results: Table 1 shows demographic data on the cohort studied. Table 2 shows length of stay data based on technology-dependence. LOS was analyzed for each GA and by need for versus no need for each technology (Figure 1). At each gestational age, there was significantly increased LOS for infants who received a tracheostomy (p < 0.001). Infants of 23- and 24-weeks GA requiring oxygen had significantly increased LOS when compared to those who did not (p < 0.001); however, need for oxygen did not affect LOS for 22-week infants (p=0.722). Only 2 infants born at 22-weeks had shunts placed, so no comparisons were made in this category due to small sample size. For 24-week infants, the presence of a shunt was associated with a significant increase in LOS (p < 0.001). G-tube placement was associated with a significantly increased LOS for each GA (p=.002 at 22-weeks’ GA; p< 0.001at 23- and 24-weeks’ GA).

Conclusion(s): Certain sequelae of extremely premature births result in the need for medical technology at
discharge. The results of this study indicate that medical technologies significantly impact LOS, regardless of GA at birth. This may be partly due to need for surgical recovery, but further information is necessary to determine all causes for increased LOS. Understanding resource use based on the need for technology-dependence at discharge may lead to better insights into extremely premature infant hospital trajectories.

Table 1: Descriptive Data Infants 22-24 Weeks


Table 2: Length of Stay Amongst Survivors with Technology Dependence


Length of Stay for Tech Dependence Across 22,23,24 week Survivors