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VOLUME 2 , ISSUE 3 ( July-September, 2023 ) > List of Articles


Neonates with an Extremely Prolonged Length of Stay: An Analysis of Kids Inpatient Database

Balagangadhar R Totapally, Naveed Hussain, Venkata Nakta Raju

Keywords : Hospital Length of Stay, Neonatal Intensive Care Unit, Pediatric Intensive Care Unit

Citation Information : Totapally BR, Hussain N, Raju VN. Neonates with an Extremely Prolonged Length of Stay: An Analysis of Kids Inpatient Database. 2023; 2 (3):179-184.

DOI: 10.5005/jp-journals-11002-0067

License: CC BY-NC 4.0

Published Online: 26-09-2023

Copyright Statement:  Copyright © 2023; The Author(s).


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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  1. Catlin A. Extremely long hospitalizations of newborns in the United States: Data, descriptions, dilemmas. J Perinatol 2006; 26(12):742–748. DOI: 10.1038/
  2. Ounpraseuth S, Bronstein J, Gauss CH, et al. Time trends and payer differences in lengths of initial hospitalization for preterm infants, Arkansas, 2004 to 2010. Am J Perinatol 2015;32(1):33–42. DOI: 10.1055/s-0034-1373843.
  3. Yu VY, Kinlay S, Orgill AA, et al. Outcome of very low birthweight infants who required prolonged hospitalization. Aust Paediatr J 1984;20(4):293–296. DOI: 10.1111/j.1440-1754.1984.tb00097.x.
  4. Cotten CM, Oh W, McDonald S, et al. Prolonged hospital stay for extremely premature infants: Risk factors, center differences, and the impact of mortality on selecting a best-performing center. J Perinatol 2005;25(10):650–655. DOI: 10.1038/
  5. Tyson JE, Younes N, Verter J, et al. Viability, morbidity, and resource use among newborns of 501- to 800-g birth weight. National Institute of Child Health and Human Development Neonatal Research Network. JAMA 1996;276(20):1645–1651. PMID: 8922450.
  6. HCUP Kids’ Inpatient Database (KID). Accessed on: 28 July 2023.
  7. Manuck TA, Rice MM, Bailit JL, et al. Preterm neonatal morbidity and mortality by gestational age: A contemporary cohort. Am J Obstet Gynecol 2016;215(1):103.e1–103.e14. DOI: 10.1016/j.ajog.2016.01.004.
  8. Yu VY, Shah V, Gomez JM, et al. Duration of hospitalization in extremely preterm infants. J Paediatr Child Health 1991;27(3):167–170. DOI: 10.1111/j.1440-1754.1991.tb00379.x.
  9. McGlacken-Byrne SM, Geraghty L, Murphy JF. The Prolonged neonatal admission: Implications for our National Children's Hospital. Irish Medical Journal 2016;109(6):428. PMID: 27814445.
  10. Meadow W, Lee G, Lin K, et al. Changes in mortality for extremely low birth weight infants in the 1990s: Implications for treatment decisions and resource use. Pediatrics 2004;113(5):1223–1229. DOI: 10.1542/peds.113.5.1223.
  11. Marcin JP, Slonim AD, Pollack MM, et al. Long-stay patients in the pediatric intensive care unit. Crit Care Med 2001;29(3):652–657. DOI: 10.1097/00003246-200103000-00035.
  12. DiBardino DJ, Pasquali SK, Hirsch JC, et al. Effect of sex and race on outcome in patients undergoing congenital heart surgery: An analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg 2012;94(6):2054–2059; discussion 2059–2060. DOI: 10.1016/j.athoracsur.2012.05.124.
  13. Peterson JK, Chen Y, Nguyen DV, et al. Current trends in racial, ethnic, and healthcare disparities associated with pediatric cardiac surgery outcomes. Congenit Heart Dis 2017;12(4):520–532. DOI: 10.1111/chd.12475.
  14. Wai KC, Keller RL, Lusk LA, et al. Trial of late surfactant study G: Characteristics of extremely low gestational age newborns undergoing tracheotomy: A secondary analysis of the trial of late surfactant randomized clinical trial. JAMA otolaryngology–head & neck surgery 2017;143(1):13–19. DOI: 10.1001/jamaoto.2016.2428.
  15. Sisk EA, Kim TB, Schumacher R, et al. Tracheotomy in very low birth weight neonates: Indications and outcomes. Laryngoscope 2006, 116(6):928–933. DOI: 10.1097/01.MLG.0000214897.08822.14.
  16. Berry MA, Shah PS, Brouillette RT, et al. Predictors of mortality and length of stay for neonates admitted to children's hospital neonatal intensive care units. J Perinatol 2008;28(4):297–302. DOI: 10.1038/
  17. Zhang Y, Ortega G, Camp M, et al. Necrotizing enterocolitis requiring surgery: Outcomes by intestinal location of disease in 4371 infants. J Pediatr Surg 2011;46(8):1475–1481. DOI: 10.1016/j.jpedsurg. 2011.03.005.
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