Center variability in risk of adjusted length of stay for very low birth weight infants in the Neocosur South American Network

Abstract

Objectives: To develop a prediction model for hospital length of stay (LOS) in very low birth weight (VLBW) infants and to compare this outcome among 20 centers within a neonatal network. Methods:Data from 7,599 infants with birth weights of 500-1,500 g born between the years 2001-2008 were prospectively collected. The Cox regression model was employed to develop two prediction models: an early model based upon variables present at birth, and a late one that adds relevant morbidities for the first 30 days of life.Results: Median adjusted estimated LOS from birth was 59 days -28 days after 30-day point of survival. There was a high correlation between models (r = 0.92). Expected/observed LOS varied widely among centers, even after correction for relevant morbidity after 30 days. Median observed LOS (range: 45-70 days), and postmenstrual age at discharge (range: 36.4-39.9 weeks) reflect high inter-center variability. Conclusion:A simple model, with factors present at birth, can predict a VLBW infant's LOS in a neonatal network. Significant variability in LOS was observed among neonatal intensive care units. We speculate that the results originate in differences in inter-center practices.J Pediatr (Rio J). 2012;88(6):524-30: Length of stay, discharge timing, hospital stay, very low birth weight infants. ResumoObjetivos: Desenvolver um modelo de predição para o tempo de permanência hospitalar (TPH) em lactentes de muito baixo peso ao nascer (MBPN) e comparar esse resultado entre 20 centros de uma rede neonatal, visto que o TPH é utilizado como uma medida da qualidade da assistência em lactentes de MBPN. Métodos IntroduçãoA grande melhoria da sobrevida de lactentes de muito baixo peso ao nascer (MBPN) observada nas últimas décadas tem sido associada a um tempo de permanência hospitalar (TPH) maior. Tanto a mortalidade quanto o TPH são fatores normalmente utilizados como medidas de qualidade da assistência de lactentes prematuros. Para controlar os perfis dos

Late preterm birth is a strong predictor of maternal stress later in life: Retrospective cohort study in school‐aged children

“…As LP infants require a longer stay in the ICU than FT infants, the stressful environment, including noise, light and painful interventions can lead to early neurological damage and changes in psychokinetic of premature infant development, and it can additionally leave long‐term neurological effects and consequences on the child's behaviour . Consequently parents, especially mothers, have difficulties with all the stressful events associated with the treatment of premature infant in the ICU as well as the separation from the child.…”

Forecasting the Length-of-Stay of Pediatric Patients in Hospitals: A Scoping Review

“…Chronically underweight newborns [36], [40], [18] Pediatric Intensive Care units Pediatric patients [27] 1…”

“…Three studies used the stepwise forward method [36], [35], [27], starting with a model with no variables and adding the most signi cant one at each iteration. In addition to the methods mentioned above, others less predominant in the studies are correlation analysis [25], [32], stepwise multiple Cox regression [40], and Principal Component Analysis (PCA) [23].…”

“…Traditional holdout randomly splits the dataset assuming that the frequency distributions do not change over time; temporal holdout divides the dataset taking into account the temporal evolution of the data. Except for two studies that do not mention the percentage of the dataset used in each partition [40], [2], all other studies used traditional holdout, varying the proportion of the dataset in the training and testing partitions, as follows: 80% -20% [27], [34], 75% -25% [35], 70% -30% [38], and 50% -50% [20], [3]. The k-fold method randomly divides the dataset into k unique parts of the same size, trains the forecast model with parts, and uses the remaining part for validation.…”

Stress in parents of very low birth weight preterm infants hospitalized in neonatal intensive care units. A multicenter study

“…A prior study conducted by the Neocosur Network found that the average length of stay of a VLBWI was 59 days. 1 Parents of VLBWIs suffer high levels of stress and face the challenge of adapting positively to this experience. [2][3][4] Several studies have reported that a high parental stress level following the birth of a preterm infant may impair the mother-child bond 5 and the possibility of establishing a secure attachment.…”