title: Can delivery room management impact the length of hospital stay in premature infants?
abstract: OBJECTIVE
  To evaluate the impact of initiating early nasal continuous positive airway pressure (ENCPAP) on the length of hospital stay (LOS) for the very low birth weight (VLBW) infants.
  
  
  METHODS
  LOS at the George Washington University Hospital (GW) after the institution of ENCPAP policy was compared to benchmark values using two-tail t-tests. The incidence of neonatal morbidity was calculated using Bonferroni corrected 95% confidence interval as compared to benchmark rates (alpha=0.001). Comparisons were repeated after stratification of the population into four birth weight subcategories: group A (GrpA) (501 to 750 g), GrpB (751 to 1000 g), GrpC (1001 to 1250 g) and GrpD (1251 to 1500 g).
  
  
  RESULTS
  We studied 228 consecutive VLBW infants (birth weight: 995+/-294 g and gestational age: 27.7+/-2.7 weeks). Compared to benchmark values, the GW experience was associated with a significant reduction of 5.1 days in LOS (55.9+/-25.2 vs 61+/-32 days; P=0.04). The decrease in LOS was consistent in all subgroups, but was most noticeable in infants of the smallest weight subcategory (LOS in GrpA=86+/-21 vs 104+/-32, P=0.004; in GrpB=69.9+/-16.7 vs 79+/-27, P=0.018; in GrpC=48.2+/-13 vs 56+/-22, P<0.001 and in GrpD=31.7+/-12.5 vs 40+/-19, P=0.003). In the overall population, a lower incidence of chronic lung disease (CLD) (17.8 vs 29%, P<0.001) was also noted. There were no differences in mortality rates (9 vs 14%), or the incidence of necrotizing enterocolitis (NEC) (8 vs 6%) or intraventricular hemorrhage (6.2 vs 9%) between GW and the established benchmark rates.
  
  
  CONCLUSIONS
  ENCPAP may reduce LOS in VLBW infants in our study population. This relatively shorter LOS was associated with a lower incidence of CLD, which may be a contributing factor.
authors.affiliation: Department of Newborn Services, The George Washington University Hospital, 900 23rd Street, Washington, DC 20037, USA. haly@mfa.gwu.edu
authors.forename: H
authors.initials: H
authors.lastname: Aly
authors.forename: A N
authors.initials: AN
authors.lastname: Massaro
authors.forename: A A E
authors.initials: AA
authors.lastname: El-Mohandes
mesh_terms: D045422:Continuous Positive Airway Pressure; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D007902:Length of Stay; D008171:Lung Diseases / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D017063:Outcome Assessment, Health Care; D011181:Postnatal Care / Q000379:methods*