Increasing Length of Stay in the NICU for Premature Newborns: Good or Bad?

In this issue of Pediatrics, Edwards et al¹ present convincing evidence that the postmenstrual age (PMA), weight, and weight z score at discharge for preterm newborns increased between 2005 and 2018. It would be reasonable to speculate that the longer length of stay (LOS) might be attributed to rising survival rates and increasingly fragile survivors. However, the researchers’ analyses suggest the opposite: the burdens of morbidities associated with prematurity appear to have decreased over time. The researchers did not have data that allowed the investigation of alternative causes of longer LOS or potential benefits that could justify longer LOS (decreasing rates of readmission, for example). The authors make the noncontroversial observation that there was a substantial monetary cost associated with the increased PMA at discharge: crude increase in median PMA of 8 days (estimated cost: $28 576) and 12 days (95% confidence interval: 11–12) when adjusted for exposure to surgery, mechanical ventilation, and morbidities associated with prematurity (estimated cost: $42 864). The increase in PMA at discharge was inversely related to gestational age at birth, …

Address correspondence to Cody Arnold, MD, MSc, 6413 Fannin St, University of Texas Health Sciences Center at Houston McGovern Medical School, Houston, TX 77030. E-mail: cody.c.arnold{at}uth.tmc.edu