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Variations in Neonatal Length of Stay of Extremely Preterm Babies: An International Comparison Between iNeo Networks

journal contribution
posted on 26.02.2021, 08:44 by Sarah Seaton, Elizabeth Draper, Mark Adams, Satoshi Kusuda, Stellan Håkansson, Kjell Helenius, Brian Reichman, Liisa Lehtonen, Dirk Bassler, Shoo Lee, Maximo Vento, Brian Darlow, Franca Rusconi, Marc Beltempo, Tetsuya Isayama, Kei Lui, Mikael Norman, Junmin Yang, Prakesh Shah, Neena Modi


To compare length of stay (LOS) in neonatal care for extremely preterm babies admitted to networks participating in the International Network for Evaluating Outcomes of Neonates (iNeo).

Study design

Data were extracted for babies admitted from 2014 to 2016 and born at 24 to 28 weeks’ gestational age (n= 28,204). Median LOS was calculated for each network for babies who survived and those who died while in neonatal care. A linear regression model was used to investigate differences in LOS between networks after adjusting for gestational age, birthweight z-score, sex, and multiplicity. A sensitivity analysis was conducted for babies who were discharged home directly.


Observed median LOS for babies who survived was longest in Japan (107 days); this result persisted after adjustment (20.7 days more than reference, 95% CI: 19.3 to 22.1). Finland had the shortest adjusted LOS (-4.8 days less than reference, 95% CI: -7.3 to -2.3). For each week’s increase in gestational age at birth, LOS decreased by 12.1 days (95% CI: -12.3 to -11.9). Multiplicity and male sex predicted mean increases in LOS of 2.6 (95% CI: 2.0 to 3.2) and 2.1 (95% CI: 1.6 to 2.6) days, respectively.results


We identified between-network differences in LOS of up to three weeks for extremely preterm babies. Some of these may be partly explained by differences in mortality, but unexplained variations may also be related to differences in clinical care practices and healthcare systems between countries.


:iNeo has been supported by the Canadian Institutes of Health Research [APR-126340 to P.S.S.]. The Australian and New Zealand Neonatal Network is predominantly funded by membership contributions from participating centers. The Canadian Neonatal Network is supported by a team grant from the Canadian Institutes of Health Research [CTP 87518], by the Ontario Ministry of Health and Long-Term Care, and by the participating centers. The Finnish Medical Birth Register is governmentally funded and kept by the National Institute for Health and Welfare (THL). The Israel Neonatal Network very low birth weight infant database is partially funded by the Israel Center for Disease Control and the Ministry of Health. The Neonatal Research Network Japan is partly funded by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan. The Spanish Neonatal Network is supported by funds from the Spanish Neonatal Society (SENeo). The Swedish Neonatal Quality Register is funded by the Swedish Government (Ministry of Health and Social Affairs), the body of regional health care providers (County Councils), and the participating units. The Swiss Neonatal Network is partially funded by participating units in the form of membership fees. The Tuscany 3 Neonatal Network is funded by the Tuscany Region. The United Kingdom Neonatal Collaborative receives no core funding. This research was also supported by Instituto de Investigación Sanitaria Carlos III (Ministry of Science, Innovation and Universities, Kingdom of Spain) [FIS17/0131 to M.V.]; and RETICS funded by the PN 2018-2021 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion, and the European Regional Development Fund (ERD


Author affiliation

Department of Health Sciences, University of Leicester


AM (Accepted Manuscript)

Published in

Journal of Pediatrics


Elsevier for Mosby



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