Factors associated with length of stay and neuromotor screening status at NICU discharge among newborns

Abstract Neonatal intensive care unit (NICU) admission is influenced by maternal, perinatal and neonatal clinical factors. Prolonged NICU length of stay (LOS) has implications for clinical counselling, discharge planning and follow-up. This study examined factors associated with NICU LOS and described neuromotor screening status at discharge among newborns admitted to two NICUs in Mangalore, India. This longitudinal observational study included 60 neonates admitted between February 2022 and February 2023. The primary outcome was NICU LOS, analyzed as both total days and predefined clinical categories of 1–5 days, 6–10 days and > 10 days. The secondary outcome was neuromotor screening status at discharge using the Infant Neurological International Battery (INFANIB), categorized as normal, transient or abnormal. Associations were examined using chi-square or Fisher’s exact tests. Multinomial logistic regression was considered exploratory because of the modest sample size and sparse cells. The mean LOS was 9.65 ± 9.36 days. Of the 60 neonates, 28 (46.7%) stayed 1–5 days, 19 (31.7%) stayed 6–10 days and 13 (21.7%) stayed > 10 days. Neonatal diagnosis was associated with LOS ( p = 0.004), with neurological disease and prematurity contributing to a larger proportion of stays > 10 days. Neonatal jaundice ( p = 0.023), sepsis ( p = 0.019), prematurity ( p = 0.014) and neonatal aspiration ( p = 0.017) were associated with LOS in unadjusted analyses. Neuromotor screening status at discharge were normal in 11 (18.3%), transient in 35 (58.3%) and abnormal in 14 (23.3%) neonates. No maternal or neonatal factor showed a statistically significant association with INFANIB category. In this exploratory cohort, neonatal clinical factors were associated with NICU LOS. Neuromotor screening status at discharge findings obtained immediately before discharge should be interpreted as early screening observations rather than validated prognostic neurodevelopmental outcomes. Larger longitudinal studies with standardized neuromotor assessment, corrected-age follow-up and methods powered for LOS analysis are required.