Factors affecting length of stay according to bronchopulmonary dysplasia severity: a nationwide cohort study in Korea

BackgroundLonger hospitalizations for preterm infants with bronchopulmonary dysplasia (BPD) delay developmental outcomes, increase the risk for hospital-acquired complications, and exert a substantial socioeconomic burden. This study aimed to identify factors associated with an extended length of stay (LOS) at different levels of severity of BPD.MethodsA cohort study was conducted using the Korean Neonatal Network registry of very low birth weight infants with BPD between 2013 and 2017 through retrospective analysis.ResultsA total of 4263 infants were diagnosed with BPD. For mild BPD, infants requiring surgical treatment for patent ductus arteriosus needed a longer LOS [eadjusted beta coefficients (adj beta) 1.041; 95% confidence interval (CI): 0.01-0.08] and hydrocephalus (eadj beta 1.094; 95% CI 0.01-0.17). In moderate BPD, infants administered steroids or with intraventricular hemorrhage required a longer LOS (eadj beta 1.041; 95% CI 0.00-0.07 and eadj beta 1.271; 95% CI 0.11-0.38, respectively). In severe BPD, infants with comorbidities required a longer LOS: pulmonary hypertension (eadj beta 1.174; 95% CI 0.09-0.23), administrated steroid for BPD (eadj beta 1.116; 95% CI 0.07-0.14), sepsis (eadj beta 1.062; 95% CI 0.01-0.11), patent ductus arteriosus requiring surgical ligation (eadj beta 1.041; 95% CI 0.00-0.08), and intraventricular hemorrhage (eadj beta 1.016; 95% CI 0.05-0.26). Additionally, the higher the clinical risk index score, the longer the LOS needed for infants in all groups.ConclusionsThe factors affecting LOS differed according to the severity of BPD. Individualized approaches to reducing LOS may be devised using knowledge of the various risk factors affecting LOS by BPD severity.