Can delivery room management impact the length of hospital stay in premature infants?

Objectives: To evaluate the impact of initiating early nasal continuous positive airway pressure (ENCPAP) on the length of hospital stay (LOS) for the very low birth weight (VLBW) infants. Study design: LOS at the George Washington University Hospital (GW) after the institution of ENCPAP policy was compared to benchmark values using two-tail t-tests. The incidence of neonatal morbidity was calculated using Bonferroni corrected 95% confidence interval as compared to benchmark rates (a¼0.001). Comparisons were repeated after stratification of the population into four birth weight subcategories: group A (GrpA) (501 to 750 g), GrpB (751 to 1000 g), GrpC (1001 to 1250 g) and GrpD (1251 to 1500 g). Results: We studied 228 consecutive VLBW infants (birth weight: 995±294 g and gestational age: 27.7±2.7 weeks). Compared to benchmark values, the GW experience was associated with a significant reduction of 5.1 days in LOS (55.9±25.2 vs 61±32 days; P¼0.04). The decrease in LOS was consistent in all subgroups, but was most noticeable in infants of the smallest weight subcategory (LOS in GrpA¼86±21 vs 104±32, P¼0.004; in GrpB¼69.9±16.7 vs 79±27, P¼0.018; in GrpC¼48.2±13 vs 56±22, P<0.001 and in GrpD¼31.7±12.5 vs 40±19, P¼0.003). In the overall population, a lower incidence of chronic lung disease (CLD) (17.8 vs 29%, P<0.001) was also noted. There were no differences in mortality rates (9 vs 14%), or the incidence of necrotizing enterocolitis (NEC) (8 vs 6%) or intraventricular hemorrhage (6.2 vs 9%) between GW and the established benchmark rates. Conclusion: ENCPAP may reduce LOS in VLBW infants in our study population. This relatively shorter LOS was associated with a lower incidence of CLD, which may be a contributing factor. Journal of Perinatology (2006) 26, 593–596. doi:10.1038/sj.jp.7211575; published online 20 July 2006