Variations in Neonatal Length of Stay of Babies Born Extremely Preterm: An International Comparison Between iNeo Networks

UK Neonatal Collaborative, International Network for Evaluating Outcomes of Neonates (iNeo) Investigators, ANZNN (Australian and New Zealand Neonatal Network), CNN (Canadian Neonatal Network), NRNJ (Neonatal Research Network Japan), SEN1500 (Spanish Neonatal Network), SwissNeoNet (Swiss Neonatal Network), FinMBR (Finnish Medical Birth Register), INN (Israel Neonatal Network), SNQ (Swedish Neonatal Quality Register), TIN Toscane online (Tuscany Neonatal Network), UKNC (United Kingdom Neonatal Collaborative)

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Objective: To compare length of stay (LOS) in neonatal care for babies born extremely preterm admitted to networks participating in the International Network for Evaluating Outcomes of Neonates (iNeo). Study design: Data were extracted for babies admitted from 2014 to 2016 and born at 24 to 28 weeks of gestational age (n = 28 204). Median LOS was calculated for each network for babies who survived and those who died while in neonatal care. A linear regression model was used to investigate differences in LOS between networks after adjusting for gestational age, birth weight z score, sex, and multiplicity. A sensitivity analysis was conducted for babies who were discharged home directly. Results: Observed median LOS for babies who survived was longest in Japan (107 days); this result persisted after adjustment (20.7 days more than reference, 95% CI 19.3-22.1). Finland had the shortest adjusted LOS (−4.8 days less than reference, 95% CI –7.3 to −2.3). For each week's increase in gestational age at birth, LOS decreased by 12.1 days (95% CI –12.3 to −11.9). Multiplicity and male sex predicted mean increases in LOS of 2.6 (95% CI 2.0-3.2) and 2.1 (95% CI 1.6-2.6) days, respectively. Conclusions: We identified between-network differences in LOS of up to 3 weeks for babies born extremely preterm. Some of these may be partly explained by differences in mortality, but unexplained variations also may be related to differences in clinical care practices and healthcare systems between countries.

Original languageEnglish
Pages (from-to)26-32.e6
JournalJournal of Pediatrics
StatePublished - Jun 2021

Bibliographical note

Publisher Copyright:
© 2021 Elsevier Inc.


The authors gratefully acknowledge the diligent work of the site investigators and data abstractors from the networks participating in the iNeo consortium and this study. We thank Heather McDonald-Kinkaid, PhD, from the Maternal-infant Care Research Centre (MiCare) in Toronto, Ontario, Canada, for editorial assistance in the preparation of this manuscript. Funding and disclosure statements available

FundersFunder number
Maternal-infant Care Research Centre


    • care provision
    • hospital admission
    • hospital discharge
    • perinatal
    • prematurity


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