Background: With scientific and technological advances in intensive care, there is an increasing survival rate among neonates with complex medical problems who experience an extremely prolonged length of stay (EPLOS) of ≥180 days in the hospital. Little is known about the antecedents and characteristics of this particular group of neonates.
Aim: To characterize the risk factors associated with EPLOS in neonates.
Patients and methods: Retrospective study of neonates from the National Hospital Discharge Database for Children, Kids Inpatient Database 2012 (KIDS-2012), maintained by the Healthcare Cost and Utilization Project (HCUP), using data from 4,170 hospitals in 44 states in the US. All neonates with complicated births who were discharged from the hospital other than from the normal newborn nursey during the year 2012 were included. Newborns with uncomplicated hospital stays who were discharged from the normal newborn nursery were excluded. Diagnoses and procedures were retrieved using ICD-9 codes. Descriptive analyses were done to identify incidence and prevalence. Comparisons were made of neonates with EPLOS (LOS ≥180 days) and non-EPLOS (LOS ≤179 days) using univariate and multivariate analyses.
Results: A total of 1,314,066 neonates with complicated births discharged from US hospitals in 2012 were included in the analysis. The incidence of EPLOS was 6.2/10,000 (n = 812). On univariate analyses, neonates with EPLOS were more likely to have the following risk factors: Black race, Medicaid insurance, ZIP codes associated with lower median incomes, and born in the South and Midwest regions of the US. Most were neonates who had a surgical procedure done, especially tracheostomy and gastrostomy, being the most common procedures.
Conclusion: The occurrence of EPLOS is relatively uncommon among hospitalized neonates. The clinical and demographic characteristics of this subset of complicated neonates are distinct and can be anticipated using prediction models. Prediction models for EPLOS may be important for public policy issues and the proper allocation of healthcare resources.
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