Abstract
Modelling length of stay in neonatal care is vital to inform service planning and the counselling of parents. Preterm babies, at the highest risk of mortality, can have long stays in neonatal care and require high resource use. Previous work has incorporated babies that die into length of stay estimates, but this still overlooks the levels of care required during their stay. This work incorporates all babies, and the levels of care they require, into length of stay estimates. Data were obtained from the National Neonatal Research Database for singleton babies born at 24–31 weeks gestational age discharged from a neonatal unit in England from 2011 to 2014. A Cox multistate model, adjusted for gestational age, was used to consider a baby’s two competing outcomes: death or discharge from neonatal care, whilst also considering the different levels of care required: intensive care; high dependency care and special care. The probabilities of receiving each of the levels of care, or having died or been discharged from neonatal care are presented graphically overall and adjusted for gestational age. Stacked predicted probabilities produced for each week of gestational age provide a useful tool for clinicians when counselling parents about length of stay and for commissioners when considering allocation of resources. Multistate modelling provides a useful method for describing the entire neonatal care pathway, where rates of in-unit mortality can be high. For a healthcare service focussed on costs, it is important to consider all babies that contribute towards workload, and the levels of care they require.
Highlights
In the UK, 1 in 8 babies require specialist neonatal care after their birth[1] and the needs of these babies can vary dramatically, both in clinical approach and the length of time they require in hospital
Data were extracted from the National Neonatal Research Database (NNRD) which holds data related to the daily neonatal care, demographics and outcomes of all babies admitted to neonatal units throughout England, Wales and Scotland
Babies were excluded if they were discharged from neonatal care having only received intensive care or were discharged having never received special care as these care pathways are clinically unusual and there was insufficient statistical power to produce reliable estimates
Summary
In the UK, 1 in 8 babies require specialist neonatal care after their birth[1] and the needs of these babies can vary dramatically, both in clinical approach and the length of time they require in hospital. For the most preterm babies who survive, this care can last several months or longer. Understanding the time babies spend in neonatal care is vital to aid the counselling of PLOS ONE | DOI:10.1371/journal.pone.0165202. Modelling Neonatal Care Pathways for Babies Born Preterm The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
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