Neonatal level of care and length of stay of moderate and late preterm infants

ObjectiveTo compare the length of hospitalization for moderate and late preterm infants (MLPIs; 32^0/7-36^6/7 weeks gestation) born at tertiary care (level III) perinatal centers versus secondary care perinatal centers (level II).MethodsThis was a retrospective cohort study of all MLPIs born at one of four perinatal centers (one tertiary and three secondary) in Calgary, Canada. All preterm infants born before 36^0/7 were routinely admitted to neonatal intensive care units (NICUs). We excluded infants with major congenital anomalies and those receiving planned palliative care. Multivariable logistic, propensity score-matched, and quantile regression analyses were used to adjust for potential confounding factors.ResultsOf the 1958 infants who met inclusion criteria, 676 (34.5%) infants were born at a tertiary care perinatal center with a level III NICU, and 1284 (65.5%) were born in secondary care perinatal centers with a level II NICU. The average gestational age was 34.8 weeks. Infants born at level II centers had shorter durations of hospital stay (adjusted mean difference [aMD] -1.0 day; 95% CI -1.7, -0.4) and tube feeding (aMD -2.2 day; 95% CI -2.9, -1.4), a lower need for peripheral intravenous access (adjusted odds ratio (aOR) 0.66; 95% CI 0.53, 0.83), reduced use of infant formula during hospitalization (aOR 0.58; 95% CI 0.43, 0.78), and a higher rate of breastmilk feeding at discharge (aOR 1.34; 95% CI 1.01, 1.77).ConclusionDelivery of MLPIs in secondary care perinatal centers is associated with shorter hospital stays and higher breastmilk feeding rates at discharge.