Respiratory insufficiency, feeding issues and length of stay in 33-36 weeks post-menstrual age infants.

BACKGROUND/AIMS: Limited post-menstrual age (PMA) stratified data are available for the morbidities and length of stay (LOS) for the largest group of preterm infants. We investigated the incidence, types and interactions of morbidities that prolong the LOS at 33-36 weeks PMA.

METHODS

Electronic and bedside charts of 1209 infants were visually reviewed. Major outcomes included respiratory support, achievement of gavage-free feeding and maternal/infant variables associated with shorter/longer than Median LOS. Fisher's exact tests/ANOVA/logistic regression were used for statistical analyses.

RESULTS

The Median (IQR, Range) of the LOS were distinct at each and even within PMA between 33 and 36 weeks (P < 0.001). 63% of infants born at 33-weeks received respiratory support vs. 46, 39 and 7% born at 34-, 35- and 36-weeks, respectively (P < 0.001). Multiple births, BW within a given PMA, SGA status, respiratory support, RDS, delayed gavage-free feeds and birthplace were associated with longer than Median LOS at each PMA (P ≤ 0.04). Achievement of gavage-free feeding was consistently the main determinant of early discharge home across all PMAs (P < 0.001).

CONCLUSIONS

Our newer approach in identifying relationship among morbidities in infant born at 33-36 weeks PMA fills important knowledge gaps. These data will facilitate evidence-based clinical care, educational-needs, health care resource planning and parental counseling.

IMPACT: Either grouped and/or fragmented data are available for morbidities in infants born between 33 and 36 weeks post-menstrual age (PMA), which represents >80% of all preterm infants. We demonstrate that respiratory insufficiency, type of respiratory support, delayed gavage-free feedings and length of stay (LOS) are inter-dependent and PMA-specific. Using a novel approach, we provide new significant data that identify clinical variables, associated with shorter and longer than Median LOS at each and even within a given PMA. Comprehensive analysis of morbidities suggests that preterm infants should neither be grouped, nor PMA alone be used for discharge planning and parental counseling.