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Background: Preterm infants (i.e., those born before 37 completed weeks of pregnancy) often require additional care and are admitted to neonatal units soon after birth. Readiness for discharge home typically requires a level of physiological maturity such that an infant is able to: 1) breathe spontaneously without additional support; 2) maintain their own body temperature; 3) take all their nutritional requirements orally; 4) weighs ≥ 1700g and is gaining weight. Longer hospital stays than necessary can be detrimental to infants, stressful for families, and costly. Currently, little is known about whether, how long and why preterm infants stay in hospital beyond physiological readiness for discharge. Materials and methods: We will conduct a retrospective cohort study using data from the National Neonatal Research Database on all infants born at < 37 weeks' gestational age (GA) admitted to neonatal units in England and Wales from 2016-2022. The day of life and postmenstrual age infants reach each physiological milestone, and the final barrier to discharge, will be identified. We will assess whether the final barrier differs by GA and between neonatal Operational Delivery Networks and summarise the number of days infants remain in hospital after surpassing all physiological milestones. We will explore the characteristics of infants, mothers and neonatal units associated with extended hospital stays beyond physiological readiness for discharge. Discussion: The results of this study will allow identification of areas to target to help achieve a safe reduction in length of hospital stay and will support the development of evidence-based recommendations to guide optimal discharge practices. Trial registration: ClinicalTrials.gov NCT06284044 [ABSTRACT FROM AUTHOR]

Objective: To predict length of stay in neonatal care for all admissions of very preterm singleton babies.Setting: All neonatal units in England.Patients: Singleton babies born at 24-31 weeks gestational age from 2011 to 2014. Data were extracted from the National Neonatal Research Database.Methods: Competing risks methods were used to investigate the competing outcomes of death in neonatal care or discharge from the neonatal unit. The occurrence of one event prevents the other from occurring. This approach can be used to estimate the percentage of babies alive, or who have been discharged, over time.Results: A total of 20 571 very preterm babies were included. In the competing risks model, gestational age was adjusted for as a time-varying covariate, allowing the difference between weeks of gestational age to vary over time. The predicted percentage of death or discharge from the neonatal unit were estimated and presented graphically by week of gestational age. From these percentages, estimates of length of stay are provided as the number of days following birth and corrected gestational age at discharge.Conclusions: These results can be used in the counselling of parents about length of stay and the risk of mortality. [ABSTRACT FROM AUTHOR]

Modelling length of stay in neonatal care is vital to inform service planning and the counselling of parents. Preterm babies, at the highest risk of mortality, can have long stays in neonatal care and require high resource use. Previous work has incorporated babies that die into length of stay estimates, but this still overlooks the levels of care required during their stay. This work incorporates all babies, and the levels of care they require, into length of stay estimates. Data were obtained from the National Neonatal Research Database for singleton babies born at 24–31 weeks gestational age discharged from a neonatal unit in England from 2011 to 2014. A Cox multistate model, adjusted for gestational age, was used to consider a baby’s two competing outcomes: death or discharge from neonatal care, whilst also considering the different levels of care required: intensive care; high dependency care and special care. The probabilities of receiving each of the levels of care, or having died or been discharged from neonatal care are presented graphically overall and adjusted for gestational age. Stacked predicted probabilities produced for each week of gestational age provide a useful tool for clinicians when counselling parents about length of stay and for commissioners when considering allocation of resources. Multistate modelling provides a useful method for describing the entire neonatal care pathway, where rates of in-unit mortality can be high. For a healthcare service focussed on costs, it is important to consider all babies that contribute towards workload, and the levels of care they require. [ABSTRACT FROM AUTHOR]

Objective: To describe neonatal outcomes and explore variation in delivery of care for infants born late (34-36  weeks) and moderately (32-33 weeks) preterm (LMPT).Design/setting: Prospective population-based study comprising births in four major maternity centres, one midwifery-led unit and at home between September 2009 and December 2010. Data were obtained from maternal and neonatal records.Participants: All LMPT infants were eligible. A random sample of term-born infants (≥37 weeks) acted as controls.Outcome Measures: Neonatal unit (NNU) admission, respiratory and nutritional support, neonatal morbidities, investigations, length of stay and postnatal ward care were measured. Differences between centres were explored.Results: 1146 (83%) LMPT and 1258 (79% of eligible) term-born infants were recruited. LMPT infants were significantly more likely to receive resuscitation at birth (17.5% vs 7.4%), respiratory (11.8% vs 0.9%) and nutritional support (3.5% vs 0.3%) and were less likely to be fed breast milk (64.2% vs 72.2%) than term infants. For all interventions and morbidities, a gradient of increasing risk with decreasing gestation was evident. Although 60% of late preterm infants were never admitted to a NNU, 83% required medical input on postnatal wards. Clinical management differed significantly between services.Conclusions: LMPT infants place high demands on specialist neonatal services. A substantial amount of previously unreported specialist input is provided in postnatal wards, beyond normal newborn care. Appropriate expertise and planning of early care are essential if such infants are managed away from specialised neonatal settings. Further research is required to clarify optimal and cost-effective postnatal management for LMPT babies. [ABSTRACT FROM AUTHOR]