Abstract 1346 Poster Session II, Sunday, 5/2 (poster 35)

There exists variation in the practice of neonatology, often a reflection of training programs. This may lead to regional differences in neonatal care delivery. These differences may result in different outcomes such as illness severity and length of stay (LOS). We hypothesized that variation in the management style of detained term infants would vary across regions, and that this variation would lead to differences in illness severity and LOS.

Methods: All infants cared for in the nursery after maternal discharge (ICN) in one of three major metropolitan areas and managed by the same disease management system (DM) were evaluated, n=4487. Term infants were divided into one of 2 categories (groupers) based on diagnostic category. Infants included had a birth weight greater than 2500 grams and were discharged between 7/1/96 and 9/30/98. Infants who required supplemental oxygen or ventilation for 24 hours or more were included in grouper G1 (n=611), and those who were without these needs were assigned to grouper G2 (n=1549). Patients (Pt.) were excluded if they had major congenital anomalies, required surgical intervention, ECMO, or died prior to discharge. The number of infants in each of these 2 groupers were compared as a percentage of the total number of infants cared for in that region. The average length of stay (ALOS) of infants in each grouper was compared, as was the percentage of total patient days (Pt.day) in each region attributed to that grouper category. Results: (Table) All values are expressed as mean±standard deviation. A star (*) indicates statistical difference between regions using multiple comparison tests (Tukey), and significance is determined by p<0.05.

Table 1 No caption available
Full size table

Conclusions: These data demonstrate that a significant variation exists in the delivery of care to term neonates among major metropolitan regions. Regions which admit fewer term infants for observation periods, G1, tend to have sick term neonates with higher acuity hospitalizations, G2, and longer LOS. This suggests that a conservative admission policy for this population may decrease overall LOS. In addition, these data suggest that similar regional differences exist for other neonatal populations, resulting in variable LOS.