Neonatal level of care and length of stay of moderate and late preterm infants

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Objective To compare the length of hospitalization for moderate and late preterm infants (MLPIs; 32 0/7 –36 6/7 weeks gestation) born at tertiary care (level III) perinatal centers versus secondary care perinatal centers (level II). Methods This was a retrospective cohort study of all MLPIs born at one of four perinatal centers (one tertiary and three secondary) in Calgary, Canada. All preterm infants born before 36 0/7 were routinely admitted to neonatal intensive care units (NICUs). We excluded infants with major congenital anomalies and those receiving planned palliative care. Multivariable logistic, propensity score-matched, and quantile regression analyses were used to adjust for potential confounding factors. Results Of the 1958 infants who met inclusion criteria, 676 (34.5%) infants were born at a tertiary care perinatal center with a level III NICU, and 1284 (65.5%) were born in secondary care perinatal centers with a level II NICU. The average gestational age was 34.8 weeks. Infants born at level II centers had shorter durations of hospital stay (adjusted mean difference [aMD] −1.0 day; 95% CI −1.7, −0.4) and tube feeding (aMD −2.2 day; 95% CI −2.9, −1.4), a lower need for peripheral intravenous access (adjusted odds ratio (aOR) 0.66; 95% CI 0.53, 0.83), reduced use of infant formula during hospitalization (aOR 0.58; 95% CI 0.43, 0.78), and a higher rate of breastmilk feeding at discharge (aOR 1.34; 95% CI 1.01, 1.77). Conclusion Delivery of MLPIs in secondary care perinatal centers is associated with shorter hospital stays and higher breastmilk feeding rates at discharge.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.