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Duration and time trends in hospital stay for very preterm infants differ across European regions
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MOSAIC and EPICE Research Groups (Including: Maier, Rolf F., Blondel, Béatrice, Piedvache, Aurélie, Misselwitz , Bjoern, Petrou, Stavros, Reempts, Patrick van, Franco, Francesco , Barros, Henrique, Gadzinowski , Janusz, Boerch , Klaus, Heijst, Arno van, Draper , Elizabeth S. and Zeitlin , Jennifer). (2018) Duration and time trends in hospital stay for very preterm infants differ across European regions. Pediatric Critical Care Medicine, 19 (12). pp. 1153-1161. doi:10.1097/PCC.0000000000001756 ISSN 1529-7535.
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Official URL: https://doi.org/10.1097/PCC.0000000000001756
Abstract
Objectives
To compare duration and changes over time in length of hospital stay for very preterm and extremely preterm infants in 10 European regions.
Design
Two area-based cohort studies from the same regions in 2003 and 2011/2012.
Setting
Ten regions from nine European countries.
Patients
Infants born between 22 + 0 and 31 + 6 weeks of gestational age and surviving to discharge (Models of Organising Access to Intensive Care for Very Preterm Births cohort in 2003, n = 4,011 and Effective Perinatal Intensive Care in Europe cohort in 2011/2012, n = 4,336).
Interventions
Observational study, no intervention.
Measurements and Main Results
Maternal and infant characteristics were abstracted from medical records using a common protocol and length of stay until discharge was adjusted for case-mix using negative binomial regression. Mean length of stay was 63.6 days in 2003 and varied from 52.4 to 76.5 days across regions. In 2011/2012, mean length of stay was 63.1 days, with a narrower regional range (54.0–70.1). Low gestational age, small for gestational age, low 5-minute Apgar score, surfactant administration, any surgery, and severe neonatal morbidities increased length of stay. Infant characteristics explained some of the differences between regions and over time, but large variations remained after adjustment. In 2011/2012, mean adjusted length of stay ranged from less than 54 days in the Northern region of the United Kingdom and Wielkopolska, Poland to over 67 days in the Ile-de-France region of France and the Eastern region of the Netherlands. No systematic decrease in very preterm length of stay was observed over time after adjustment for patient case-mix.
Conclusions
A better understanding of the discharge criteria and care practices that contribute to the wide differences in very preterm length of stay across European regions could inform policies to optimize discharge decisions in terms of infant outcomes and health system costs.
Item Type: | Journal Article | ||||||||||||||||||||||||||||||||||||||||||
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Subjects: | R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services | ||||||||||||||||||||||||||||||||||||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Premature infants -- Hospitals -- Length of stay -- Regional disparities -- Europe | ||||||||||||||||||||||||||||||||||||||||||
Journal or Publication Title: | Pediatric Critical Care Medicine | ||||||||||||||||||||||||||||||||||||||||||
Publisher: | Lippincott Williams & Wilkins | ||||||||||||||||||||||||||||||||||||||||||
ISSN: | 1529-7535 | ||||||||||||||||||||||||||||||||||||||||||
Official Date: | December 2018 | ||||||||||||||||||||||||||||||||||||||||||
Dates: |
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Volume: | 19 | ||||||||||||||||||||||||||||||||||||||||||
Number: | 12 | ||||||||||||||||||||||||||||||||||||||||||
Page Range: | pp. 1153-1161 | ||||||||||||||||||||||||||||||||||||||||||
DOI: | 10.1097/PCC.0000000000001756 | ||||||||||||||||||||||||||||||||||||||||||
Status: | Peer Reviewed | ||||||||||||||||||||||||||||||||||||||||||
Publication Status: | Published | ||||||||||||||||||||||||||||||||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||||||||||||||||||||||||||||||||||||
Date of first compliant deposit: | 29 August 2018 | ||||||||||||||||||||||||||||||||||||||||||
Date of first compliant Open Access: | 18 December 2018 | ||||||||||||||||||||||||||||||||||||||||||
RIOXX Funder/Project Grant: |
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