Factors Affecting Length of Stay According to Bronchopulmonary Dysplasia Severity: a Nationwide Cohort Study in Korea

Overview

Journal World J Pediatr

Specialty Pediatrics

Date 2024 Feb 15

PMID 38356035

Authors

Hye Mi Lee

Jeongmin Shin

Sae Yun Kim

So Young Kim

Affiliations

Soon will be listed here.

Abstract

Background: Longer hospitalizations for preterm infants with bronchopulmonary dysplasia (BPD) delay developmental outcomes, increase the risk for hospital-acquired complications, and exert a substantial socioeconomic burden. This study aimed to identify factors associated with an extended length of stay (LOS) at different levels of severity of BPD.

Methods: A cohort study was conducted using the Korean Neonatal Network registry of very low birth weight infants with BPD between 2013 and 2017 through retrospective analysis.

Results: A total of 4263 infants were diagnosed with BPD. For mild BPD, infants requiring surgical treatment for patent ductus arteriosus needed a longer LOS [e 1.041; 95% confidence interval (CI): 0.01-0.08] and hydrocephalus (e 1.094; 95% CI 0.01-0.17). In moderate BPD, infants administered steroids or with intraventricular hemorrhage required a longer LOS (e 1.041; 95% CI 0.00-0.07 and e 1.271; 95% CI 0.11-0.38, respectively). In severe BPD, infants with comorbidities required a longer LOS: pulmonary hypertension (e 1.174; 95% CI 0.09-0.23), administrated steroid for BPD (e 1.116; 95% CI 0.07-0.14), sepsis (e 1.062; 95% CI 0.01-0.11), patent ductus arteriosus requiring surgical ligation (e 1.041; 95% CI 0.00-0.08), and intraventricular hemorrhage (e 1.016; 95% CI 0.05-0.26). Additionally, the higher the clinical risk index score, the longer the LOS needed for infants in all groups.

Conclusions: The factors affecting LOS differed according to the severity of BPD. Individualized approaches to reducing LOS may be devised using knowledge of the various risk factors affecting LOS by BPD severity.

References

Kim S, Han Y, Chun J, Lee M, Sung T . Risk factors that affect the degree of bronchopulmonary dysplasia: Comparison by severity in the same gestational age. PLoS One. 2020; 15(7):e0235901. PMC: 7365464. DOI: 10.1371/journal.pone.0235901. View

Xu Y, Shi L, Du L . Continuing interventions in a quality improvement bundle to reduce bronchopulmonary dysplasia. World J Pediatr. 2022; 18(4):278-282. DOI: 10.1007/s12519-021-00508-y. View

Morrow C, McGrath-Morrow S, Collaco J . Predictors of length of stay for initial hospitalization in infants with bronchopulmonary dysplasia. J Perinatol. 2018; 38(9):1258-1265. PMC: 6195847. DOI: 10.1038/s41372-018-0142-7. View

Yeh J, McGrath-Morrow S, Collaco J . Oxygen weaning after hospital discharge in children with bronchopulmonary dysplasia. Pediatr Pulmonol. 2016; 51(11):1206-1211. PMC: 5556369. DOI: 10.1002/ppul.23442. View

Robinson S . Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatr. 2012; 9(3):242-58. PMC: 3842211. DOI: 10.3171/2011.12.PEDS11136. View

Chang Y, Park H, Park W . The Korean Neonatal Network: An Overview. J Korean Med Sci. 2015; 30 Suppl 1:S3-S11. PMC: 4641061. DOI: 10.3346/jkms.2015.30.S1.S3. View

Zeitlin J, Szamotulska K, Drewniak N, Mohangoo A, Chalmers J, Sakkeus L . Preterm birth time trends in Europe: a study of 19 countries. BJOG. 2013; 120(11):1356-65. PMC: 4285908. DOI: 10.1111/1471-0528.12281. View

Adams M, Bassler D, Bucher H, Roth-Kleiner M, Berger T, Braun J . Variability of Very Low Birth Weight Infant Outcome and Practice in Swiss and US Neonatal Units. Pediatrics. 2018; 141(5). DOI: 10.1542/peds.2017-3436. View

Htun Z, Schulz E, Desai R, Marasch J, McPherson C, Mastrandrea L . Postnatal steroid management in preterm infants with evolving bronchopulmonary dysplasia. J Perinatol. 2021; 41(8):1783-1796. PMC: 8133053. DOI: 10.1038/s41372-021-01083-w. View

10.

Jobe A, Bancalari E . Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001; 163(7):1723-9. DOI: 10.1164/ajrccm.163.7.2011060. View

11.

Isayama T, Lee S, Yang J, Lee D, Daspal S, Dunn M . Revisiting the Definition of Bronchopulmonary Dysplasia: Effect of Changing Panoply of Respiratory Support for Preterm Neonates. JAMA Pediatr. 2017; 171(3):271-279. DOI: 10.1001/jamapediatrics.2016.4141. View

12.

Fu M, Song W, Yu G, Yu Y, Yang Q . Risk factors for length of NICU stay of newborns: A systematic review. Front Pediatr. 2023; 11:1121406. PMC: 10040659. DOI: 10.3389/fped.2023.1121406. View

13.

. An international classification of retinopathy of prematurity. The Committee for the Classification of Retinopathy of Prematurity. Arch Ophthalmol. 1984; 102(8):1130-4. DOI: 10.1001/archopht.1984.01040030908011. View

14.

Thebaud B, Goss K, Laughon M, Whitsett J, Abman S, Steinhorn R . Bronchopulmonary dysplasia. Nat Rev Dis Primers. 2019; 5(1):78. PMC: 6986462. DOI: 10.1038/s41572-019-0127-7. View

15.

NORTHWAY Jr W, ROSAN R, Porter D . Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med. 1967; 276(7):357-68. DOI: 10.1056/NEJM196702162760701. View

16.

Papile L, BURSTEIN J, Burstein R, KOFFLER H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978; 92(4):529-34. DOI: 10.1016/s0022-3476(78)80282-0. View

17.

Lee J, Lee H, Park H, Ahn J, Kim H, Jang H . Surgical ligation of patent ductus arteriosus in preterm neonates weighing less than 1500g: a 9-year single center experience. J Cardiothorac Surg. 2020; 15(1):144. PMC: 7298442. DOI: 10.1186/s13019-020-01191-2. View

18.

Su B, Hsieh W, Hsu C, Chang J, Lien R, Lin C . Neonatal outcomes of extremely preterm infants from taiwan: comparison with Canada, Japan, and the USA. Pediatr Neonatol. 2014; 56(1):46-52. DOI: 10.1016/j.pedneo.2014.05.002. View

19.

Fenton T, Kim J . A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013; 13:59. PMC: 3637477. DOI: 10.1186/1471-2431-13-59. View

20.

Lee J, Noh O, Chang Y . Neonatal Outcomes of Very Low Birth Weight Infants in Korean Neonatal Network from 2013 to 2016. J Korean Med Sci. 2019; 34(5):e40. PMC: 6356024. DOI: 10.3346/jkms.2019.34.e40. View