Factors associated with long stay in hospital for preterm newborns

Menezes, Micheline Soares Diniz; Rodrigues, Jady Emanuelle Santos; Mendonça, Iuri Pedro; Caldeira, Antônio Prates

doi:10.1590/1806-9304202500000243-en

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 25 • 2025 • https://doi.org/10.1590/1806-9304202500000243-en linkcopy

Factors associated with long stay in hospital for preterm newborns

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives: to identify factors associated with long hospital stays among preterm newborns.

Methods: this is a retrospective cohort study, conducted in an outpatient clinic monitoring high-risk newborns in Northern Minas Gerais. All morbidities in the group were recorded according to the prematurity classification. Long stay was defined based on the last quartile of times, in days of stay, for the group evaluated. The variables associated with long hospital stay were defined using bivariate analysis followed by binary logistic regression, with only variables with a significance level of 5% remaining in the final model.

Results: 293 newborns participated in this study, 56.6% of whom were male. The gestational age of the group ranged from 24 to 36 weeks, and 25.3% were extremely preterm. The main morbidities were related to respiratory and infectious disorders. Long stays were recorded for 25.9% of preterm newborns and the associated factors were gestational age (p<0.001), birth weight (p<0.001), late-onset sepsis (p<0.001) and necrotizing enterocolitis (p=0.036).

Conclusion: the factors associated with long stays highlight the need for greater vigilance in prenatal care, with safe monitoring of pregnancy and prevention of prematurity, and post-natal care, with strict surveillance in the prevention of nosocomial infections.

Key words
Infant premature; Morbidity; Length of stay; Neonatal intensive care units

Morbidities and complications	Total	Gestational age							p *
	Total	<28 weeks (n=41)		28-31 weeks (n=104)			32-36 weeks (n=148)
	n	%	n	%	n	%	n	(%)
RDS	275	93.9	41	100.0	101	97.1	133	89.9	0.013
Early-onset sepsis	141	48.1	29	70.7	59	56.7	53	35.8	<0.001
Apnea	115	39.2	28	68.3	60	57.7	27	18.2	<0.001
Late-onset sepsis	63	21.5	16	39.0	27	26.0	20	13.5	0.001
Bronchopulmonary Dysplasia	62	21.2	27	65.9	28	26.9	7	4.7	<0.001
Hemodynamic Instability	60	20.5	19	46.3	27	26.0	14	9.5	<0.001
ICH	35	11.9	18	43.9	14	13.5	3	2.0	<0.001
Necrotizing enterocolitis	22	7.5	5	12.2	12	11.5	5	3.4	0.025
Hypoglycemia	15	5.1	4	9.8	5	4.8	6	4.1	0.336
Seizures	14	4.8	6	14.6	7	6.7	1	0.7	0.001

Variables	N	%	Prolonged stay*				OR (95% CI) crude	p **
			Yes		No
			n	%	n	%
Gestational age (weeks)
< 28	41	14.0	36	87.8	5	12.2	205.92 (56.55-749.82)	<0.001
28 - 31	104	35.5	35	33.7	69	66.3	14.19 (5.12-39.36)	<0.001
32 - 36	148	50.5	5	3.4	143	96.6	1.00
Sex
Male	163	55.6	36	22.1	127	77.9	0.64 (0.38-1.08)	0.092
Female	130	44.4	40	30.8	90	69.2	1.0
Birthweight(g)
<1.000	57	19.5	47	82.5	10	17.5	84.01 (31.33-225.28)	<0.001
1.000 - 1.499	85	29.0	21	24.7	64	75.3	5.86 (2.47-13.94)	<0.001
1.500 - 2499	151	51.5	8	5.3	143	94.7	1.00
Resuscitation at birth
Yes	56	19.1	24	42.9	32	57.1	2.67 (1.45-4.92)	0.001
No	237	80.9	52	21.9	185	78.1	1.00
Mother’s use of corticosteroid
Yes	134	45.7	50	37.3	84	62.7	3.05 (1.76-5.26)	<0.001
No	159	54.3	26	16.4	133	83.6	1.0
Maternal hypertension
Yes	81	27.6	21	25.9	60	74.1	0.99 (0.56-1.79)	0.998
No	212	72.4	55	25.9	157	74.1	1.0
Gestational diabetes
Yes	23	7.8	5	21.7	18	78.3	0.78 (0.28-2.17)	0.632
No	270	92.2	71	26.3	199	73.7	1.0
Urinary tract infection
Yes	46	15.7	8	17.4	38	82.6	0.55 (0.25-1.25)	0.150
No	247	84.3	68	27.5	197	72.5	1.0

Variables	N	%	Prolonged stay*				OR (95%CI) crude	p **
			Yes		No
			n	%	n	%
Surfactants use
Yes	90	30.7	46	51.1	44	48.9	6.03 (3.42-10.63)	<0.001
No	203	69.3	30	15.4	173	85.2	1.00
Seizures
Yes	14	4.8	10	71.4	4	28.6	8.07 (2.45-26.57)	<0.001
No	279	95.2	66	23.7	213	76.3	1.00
Apneas
Yes	115	39.2	49	42.6	66	57.4	4.15 (2.39-7.21)	<0.001
No	178	60.8	27	15.2	151	84.8	1.00
Bronchopulmonary Dysplasia
Yes	62	21.2	39	62.9	23	37.1	8.89 (4.76-16.59)	<0.001
No	231	78.8	37	16.0	194	84.0	1.00
Early-onset sepsis
Yes	141	48.1	51	36.2	90	63.8	2.87 (1.66-4.98)	<0.001
No	152	51.9	25	16.4	127	83.6	1.00
Late-onset sepsis
Yes	63	21.5	36	57.1	27	42.9	6.33 (3.46-11.59)	<0.001
No	230	78.5	40	17.4	190	82.6	1.00
Occurrence of hemorrhage (ICH)
Yes	35	11.9	19	54.3	16	45.7	4.19 (2.02-8.66)	<0.001
No	258	88.1	57	22.1	201	77.9	1.00
Necrotizing enterocolitis
Yes	22	7.5	13	59.1	9	40.9	4.77 (1.95-11.68)	<0.001
No	271	92.5	63	23.2	208	76.8	1.00
Hemodynamic instability
Yes	60	20.5	29	48.3	31	51.7	3.70 (2.03-6.74)	<0.001
No	233	79.5	47	20.2	186	79.8	1.00

Independent variables	Prolonged stay**
Independent variables	OR adjusted	95%CI	p
Gestational age (weeks)
<28	56.88	11.27-286.97	<0.001
28-31	7.67	2.35-25.01	0.001
32-36	1.00
Birthweight (g)
<1.000	10.21	2.84-36.63	<0.001
1.000-1.499	9.61	3.38-27.32	<0.001
1.500-2.499	1.00
Late-onset sepsis			<0.001
Yes	6.10	2.45-15.19
No	1.00
Necrotizing enterocolitis
Yes	3.97	1.09-14.40	0.036
No	1.00

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[TN1] RDS=Respiratory Distress Syndrome; ICH=Intracranial Hemorrhage;

[TN2] ^*
Pearson’s chi-square test.