Duration and Time Trends in Hospital Stay for Very Preterm Infants Differ Across European Regions*

Objectives: To compare duration and changes over time in length of hospital stay for very preterm and extremely preterm infants in 10 European regions. Design: Two area-based cohort studies from the same regions in 2003 and 2011/2012. Setting: Ten regions from nine European countries. Patients: Infants born between 22 + 0 and 31 + 6 weeks of gestational age and surviving to discharge (Models of Organising Access to Intensive Care for Very Preterm Births cohort in 2003, n = 4,011 and Effective Perinatal Intensive Care in Europe cohort in 2011/2012, n = 4,336). Interventions: Observational study, no intervention. Measurements and Main Results: Maternal and infant characteristics were abstracted from medical records using a common protocol and length of stay until discharge was adjusted for case-mix using negative binomial regression. Mean length of stay was 63.6 days in 2003 and varied from 52.4 to 76.5 days across regions. In 2011/2012, mean length of stay was 63.1 days, with a narrower regional range (54.0-70.1). Low gestational age, small for gestational age, low 5-minute Apgar score, surfactant administration, any surgery, and severe neonatal morbidities increased length of stay. Infant characteristics explained some of the differences between regions and over time, but large variations remained after adjustment. In 2011/2012, mean adjusted length of stay ranged from less than 54 days in the Northern region of the United Kingdom and Wielkopolska, Poland to over 67 days in the Ile-de-France region of France and the Eastern region of the Netherlands. No systematic decrease in very preterm length of stay was observed over time after adjustment for patient case-mix. Conclusions: A better understanding of the discharge criteria and care practices that contribute to the wide differences in very preterm length of stay across European regions could inform policies to optimize discharge decisions in terms of infant outcomes and health system costs.The Models of Organising Access to Intensive Care for Very Preterm Births project was funded by a grant from the European Commission Research Directorate (QLG4-CT-2001-01907). The Effective Perinatal Intensive Care in Europe (EPICE) project was funded from the European Union's Seventh Framework Programme (2007-2013) under grant agreement no 259882. This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 633724. Additional funding was received for the EPICE project in the following regions: France (French Institute of Public Health Research/Institute of Public Health and its partners the French Health Ministry, the National Institute of Health and Medical Research, the National Institute of Cancer, and the National Solidarity Fund for Autonomy; grant ANR-11-EQPX-0038 from the National Research Agency through the French Equipex Program of Investments in the Future; and the PremUp Foundation); Poland (2012-2015 allocation of funds for international projects from the Polish Ministry of Science and Higher Education); and United Kingdom (funding for The Neonatal Survey from Neonatal Networks for East Midlands and Yorkshire & Humber regions.; Dr. Maier's institution received funding from European Commission Research Directorate (QLG4-CT-2001-01907); European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement No 259882; and European Union's Horizon 2020 research and innovation programme under grant agreement No 633724. Dr. Van Reempts' institution received funding from Centre of Perinatal Epidemiology in Flanders. Dr. Franco disclosed government work. Drs. Gadzinowski's and Draper's institutions received funding from European Union FP7, and they received support for article research from European Union FP7. Dr. Draper disclosed work for hire. Dr. Zeitlin's institution received funding from European Commission. The remaining authors have disclosed that they do not have any potential conflicts of interest