Am J Perinatol
DOI: 10.1055/a-1712-5313
Original Article

Trends in length of stay for Neonatal Intensive Care Unit patients who die before hospital discharge

1  Division of Newborn Medicine, Department of Pediatrics, the Icahn School of Medicine at Mount Sinai, New York, New York
,
Nicholas Puoplo
2  Department of Pediatrics, the Icahn School of Medicine at Mount Sinai, New York, New York
,
Felix Richter
3  Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
,
Andrea S. Weintraub
1  Division of Newborn Medicine, Department of Pediatrics, the Icahn School of Medicine at Mount Sinai, New York, New York
› Author Affiliations
Funding None.

Abstract

Objectives The objectives of this study were to establish days between birth and death for neonates over a 14-year period, determine if days between birth and death have changed over time across gestational age cohorts, and identify diagnoses which may put infants at high risk of prolonged hospitalization leading to death.

Study Design This was a single-site, retrospective chart review of inborn infants who died prior to hospital discharge.

Results Two hundred and thirty-nine patients born between 1/1/2006 and 12/31/2020 met inclusion criteria. Days until death ranged from 0 to 300 with a median of 6 days (interquartile range = 23). Median days until death increased over time, with a statistically significant increase between epoch 1 and epoch 2 (p = 0.016) but not between epoch 2 and epoch 3 (p = 0.618). Extremely premature infants died earlier than more mature infants (p < 0.001). In addition, infants with complex congenital heart disease or a gastrointestinal (GI) catastrophe died later (p < 0.001 and p < 0.001, respectively) than newborns without cardiac or GI issues.

Conclusions Our findings demonstrate an increase in time to death for newborns who did not survive to hospital discharge over a 14-year period. This trend suggests that the dynamics informing Meadows' assertion that “doomed infants die early” may be shifting, with some seriously ill infants who die before hospital discharge surviving longer than previously described. More research is needed to understand how best to care for babies who will not survive to discharge and to explore when supports such as palliative care consultation may be beneficial.

Key Points

As per W. Meadow, “Doomed infants die early”

  • Pre-death length of stay varies with diagnosis.

  • Some seriously ill infants who die before hospital discharge are no longer dying early.

  • These infants and families may need supports.



Publication History

Received: 07 July 2021

Accepted: 01 December 2021

Publication Date:
03 December 2021 (online)

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