{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T02:49:13Z","timestamp":1792464553298,"version":"4.5.0"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T00:00:00Z","timestamp":1678665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The improvement in survival of preterm infants is accompanied by an increase in neonatal intensive care unit (NICU) admissions. Prolonged length of stay in the NICU (LOS-NICU) increases the incidence of neonatal complications and even mortality and places a significant economic burden on families and strain on healthcare systems. This review aims to identify risk factors influencing LOS-NICU of newborns and to provide a basis for interventions to shorten LOS-NICU and avoid prolonged LOS-NICU.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic literature search was conducted in PubMed, Web of Science, Embase, and Cochrane library for studies that were published in English from January 1994 to October 2022. The PRISMA guidelines were followed in all phases of this systematic review. The Quality in Prognostic Studies (QUIPS) tool was used to assess methodological quality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty-three studies were included, 5 of which were of high quality and 18 of moderate quality, with no low-quality literature. The studies reported 58 possible risk factors in six broad categories (inherent factors; antenatal treatment and maternal factors; diseases and adverse conditions of the newborn; treatment of the newborn; clinical scores and laboratory indicators; organizational factors).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We identified several of the most critical risk factors affecting LOS-NICU, including birth weight, gestational age, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. As only a few high-quality studies are available at present, well-designed and more extensive prospective studies investigating the risk factors affecting LOS-NICU are still needed in the future.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2023.1121406","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T05:12:57Z","timestamp":1678684377000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":75,"title":["Risk factors for length of NICU stay of newborns: A systematic review"],"prefix":"10.3389","volume":"11","author":[{"given":"Maoling","family":"Fu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenshuai","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genzhen","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqi","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoyue","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.783900","article-title":"Association between NT-proBNP and prolonged length of stay in hospital among preterm infants born at 28\u201331 weeks\u2019 gestation","volume":"9","author":"Ge","year":"2021","journal-title":"Front Pediatr"},{"key":"B2","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1038\/jp.2016.183","article-title":"State of newborn health in India","volume":"36","author":"Sankar","year":"2016","journal-title":"J Perinatol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1001\/jamapediatrics.2014.3351","article-title":"Survival and morbidity of preterm children born at 22 through 34 weeks\u2019 gestation in France in 2011 results of the EPIPAGE-2 cohort study","volume":"169","author":"Ancel","year":"2015","journal-title":"JAMA Pediatr"},{"key":"B4","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1001\/jama.2021.23580","article-title":"Mortality, in-hospital morbidity, care practices, and 2-year outcomes for extremely preterm infants in the US, 2013\u20132018","volume":"327","author":"Bell","year":"2022","journal-title":"JAMA"},{"key":"B5","doi-asserted-by":"publisher","first-page":"147.e1","DOI":"10.1016\/j.ajog.2006.09.014","article-title":"Trends in neonatal morbidity and mortality for very low birthweight infants","volume":"196","author":"Fanaroff","year":"2007","journal-title":"Am J Obstet Gynecol"},{"key":"B6","first-page":"7","article-title":"A survey of neonatal births in maternity departments in urban China in 2005","volume":"14","author":"Li","year":"2012","journal-title":"Zhongguo Dang Dai Er Ke Za Zhi"},{"key":"B7","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.jpeds.2017.08.028","article-title":"Regional variation in neonatal intensive care admissions and the relationship to bed supply","volume":"192","author":"Harrison","year":"2018","journal-title":"J Pediatr"},{"key":"B8","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1001\/jamapediatrics.2015.1305","article-title":"Epidemiologic trends in neonatal intensive care, 2007\u20132012","volume":"169","author":"Harrison","year":"2015","journal-title":"JAMA Pediatr"},{"key":"B9","doi-asserted-by":"publisher","first-page":"E146","DOI":"10.1542\/peds.2009-0810","article-title":"Predicting time to hospital discharge for extremely preterm infants","volume":"125","author":"Hintz","year":"2010","journal-title":"Pediatrics"},{"key":"B10","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1097\/01.ANC.0000267913.58726.f3","article-title":"Clinical outcomes and cost of the moderately preterm infant","volume":"7","author":"Kirkby","year":"2007","journal-title":"Adv Neonatal Care"},{"key":"B11","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/s1084-2756(02)00219-1","article-title":"Early NICU discharge of very low birth weight infants: a critical review and analysis","volume":"8","author":"Merritt","year":"2003","journal-title":"Semin Neonatol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/S0210-5691(06)74498-9","article-title":"Cost of quality in intensive medicine. Guidelines for clinical management","volume":"30","author":"Carrasco","year":"2006","journal-title":"Med Intensiva"},{"key":"B13","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1097\/mop.0000000000000190","article-title":"Impact of hospital-based environmental exposures on neurodevelopmental outcomes of preterm infants","volume":"27","author":"Santos","year":"2015","journal-title":"Curr Opin Pediatr"},{"key":"B14","doi-asserted-by":"publisher","first-page":"164","DOI":"10.4067\/s0370-41062014000200005","article-title":"Factors associated with prolonged hospital stay in infants","volume":"85","author":"Mendoza T","year":"2014","journal-title":"Rev Chil Pediatr"},{"key":"B15","doi-asserted-by":"publisher","first-page":"235","DOI":"10.7888\/juoeh.39.235","article-title":"Family-centered care in neonatal intensive care units: combining intensive care and family support","volume":"39","author":"Araki","year":"2017","journal-title":"J UOEH"},{"key":"B16","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1007\/s10880-010-9202-7","article-title":"Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the neonatal intensive care unit (NICU)","volume":"17","author":"Lefkowitz","year":"2010","journal-title":"J Clin Psychol Med Settings"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2021.100212","article-title":"A cross-sectional nationwide study on accessibility and availability of neonatal care resources in hospitals of China: current situation. Mortality and regional differences","volume":"14","author":"Li","year":"2021","journal-title":"Lancet Reg Health West Pac"},{"key":"B18","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1038\/jp.2012.62","article-title":"Neonatal intensive care unit: predictive models for length of stay","volume":"33","author":"Bender","year":"2013","journal-title":"J Perinatol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1542\/peds.2005-2909","article-title":"Neonatal intensive care unit census influences discharge of moderately preterm infants","volume":"119","author":"Profit","year":"2007","journal-title":"Pediatrics"},{"key":"B20","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1542\/peds.2012-1999","article-title":"Levels of neonatal care","volume":"130","author":"Barfield","year":"2012","journal-title":"Pediatrics"},{"key":"B21","doi-asserted-by":"publisher","first-page":"777","DOI":"10.7326\/m14-2385","article-title":"The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann Intern Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1136\/adc.2003.046268","article-title":"Changes in mortality and morbidities among infants born at less than 25 weeks during the post-surfactant era","volume":"90","author":"Hintz","year":"2005","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B23","doi-asserted-by":"publisher","first-page":"280","DOI":"10.7326\/0003-4819-158-4-201302190-00009","article-title":"Assessing bias in studies of prognostic factors","volume":"158","author":"Hayden","year":"2013","journal-title":"Ann Intern Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1584","DOI":"10.1111\/jpc.15031","article-title":"Predictors of length of hospital stay among preterm infants admitted to neonatal intensive care unit: data from a multicentre collaborative network from India (INNC: Indian National Neonatal Collaborative)","volume":"56","author":"Murki","year":"2020","journal-title":"J Paediatr Child Health"},{"key":"B25","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.ijid.2015.04.017","article-title":"Infections and risk-adjusted length of stay and hospital mortality in Polish Neonatology Intensive Care Units","volume":"35","author":"R\u00f3\u017ca\u0144ska","year":"2015","journal-title":"Int J Infect Dis"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2333794X20968715-2333794X","DOI":"10.1177\/2333794(20968715","article-title":"Which factors predict hospital length-of-stay for children admitted to the neonatal intensive care unit and pediatric ward? A hospital-based prospective study","volume":"7","author":"Sahiledengle","year":"2020","journal-title":"Glob Pediatr Health"},{"key":"B27","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1038\/jp.2013.92","article-title":"Accounting for variation in length of NICU stay for extremely low birth weight infants","volume":"33","author":"Lee","year":"2013","journal-title":"J Perinatol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1038\/sj.jp.7211904","article-title":"Predictors of mortality and length of stay for neonates admitted to children's hospital neonatal intensive care units","volume":"28","author":"Berry","year":"2008","journal-title":"J Perinatol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/s2352-4642(17)30069-x","article-title":"Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study","volume":"1","author":"Jetton","year":"2017","journal-title":"Lancet Child Adolesc Health"},{"key":"B30","doi-asserted-by":"publisher","first-page":"3553","DOI":"10.3109\/14767058.2016.1138466","article-title":"Evaluation of the maternal and fetal risk factors associated with neonatal care unit hospitalization time","volume":"29","author":"Eken","year":"2016","journal-title":"J Matern Fetal Neonatal Med"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-82957-z","article-title":"Designing a bed-side system for predicting length of stay in a neonatal intensive care unit","volume":"11","author":"Singh","year":"2021","journal-title":"Sci Rep"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1177\/03000605221100753","article-title":"Length of stay and influencing factors of NICU in the Western Hunan, an underdeveloped area of China: a 9-year retrospective study","volume":"50","author":"Xie","year":"2022","journal-title":"J Int Med Res"},{"key":"B33","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1007\/s12519-021-00494-1","article-title":"Variations in length of stay among survived very preterm infants admitted to Chinese neonatal intensive care units","volume":"18","author":"Zhang","year":"2022","journal-title":"World J Pediatr"},{"key":"B34","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1055\/s-0036-1572433","article-title":"Estimating length of stay by patient type in the neonatal intensive care unit","volume":"33","author":"Lee","year":"2016","journal-title":"Am J Perinatol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"184","DOI":"10.2215\/cjn.03670318","article-title":"Incidence and risk factors of early onset neonatal AKI","volume":"14","author":"Charlton","year":"2019","journal-title":"Clin J Am Soc Nephrol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1972","DOI":"10.1080\/14767058.2016.1235696","article-title":"Major determinants of survival and length of stay in the neonatal intensive care unit of newborns from women with premature preterm rupture of membranes","volume":"30","author":"Eken","year":"2017","journal-title":"J Matern Fetal Neonatal Med"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.1080\/08035250510046722","article-title":"Risk factors for delayed discharge home in very-low-birthweight infants\u2014a population-based study","volume":"94","author":"Klinger","year":"2005","journal-title":"Acta Paediatr"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1740154","article-title":"The Hassan neonatal morbidity composite scale and neonatal length of stay\u2014a validation study","author":"Patil","year":"2021","journal-title":"Am J Perinatol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1542\/peds.114.2.348","article-title":"Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants","volume":"114","author":"Payne","year":"2004","journal-title":"Pediatrics"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/bmjopen-2011-000792","article-title":"Factors associated with mortality and length of stay in hospitalised neonates in Eritrea, Africa: a cross-sectional study","volume":"2","author":"Shah","year":"2012","journal-title":"BMJ Open"},{"key":"B41","doi-asserted-by":"publisher","first-page":"960","DOI":"10.3109\/14767058.2011.572204","article-title":"Premature infants born after preterm premature rupture of membranes with 24-34 weeks of gestation: a study of factors influencing length of neonatal intensive care unit stay","volume":"24","author":"Ye","year":"2011","journal-title":"J Matern Fetal Neonatal Med"},{"key":"B42","doi-asserted-by":"publisher","first-page":"166","DOI":"10.4314\/ahs.v12i2.14","article-title":"Predicting mortality and length-of-stay for neonatal admissions to private hospital neonatal intensive care units: a Southern African retrospective study","volume":"12","author":"Pepler","year":"2012","journal-title":"Afr Health Sci"},{"key":"B43","doi-asserted-by":"publisher","first-page":"361","DOI":"10.3345\/cep.2019.00437","article-title":"Evaluation of goodness of fit of semiparametric and parametric models in analysis of factors associated with length of stay in neonatal intensive care unit","volume":"63","author":"Kheiry","year":"2020","journal-title":"Clin Exp Pediatr"},{"key":"B44","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.bpobgyn.2018.01.022","article-title":"The biological basis and prevention of preterm birth","volume":"52","author":"Di Renzo","year":"2018","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0165202","article-title":"Modelling neonatal care pathways for babies born preterm: an application of multistate modelling","volume":"11","author":"Seaton","year":"2016","journal-title":"PLoS One"},{"key":"B46","doi-asserted-by":"publisher","first-page":"F170","DOI":"10.1136\/archdischild-2016-310944","article-title":"Estimating discharge dates using routinely collected data: improving the preparedness of parents of preterm infants for discharge home","volume":"102","author":"Fleming","year":"2017","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B47","doi-asserted-by":"publisher","first-page":"F182","DOI":"10.1136\/archdischild-2017-314405","article-title":"Estimating neonatal length of stay for babies born very preterm","volume":"104","author":"Seaton","year":"2019","journal-title":"Arch Dis \\Child Fetal Neonatal Ed"},{"key":"B48","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1097\/01.AOG.0000251610.51286.b1","article-title":"Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth","volume":"109","author":"Roberts","year":"2007","journal-title":"Obstet Gynecol"},{"key":"B49","doi-asserted-by":"publisher","first-page":"2162","DOI":"10.1016\/s0140-6736(12)60820-4","article-title":"National, regional, and worldwide estimates of preterm birth rates in the year 2010\u00a0with time trends since 1990 for selected countries: a systematic analysis and\u00a0implications","volume":"379","author":"Blencowe","year":"2012","journal-title":"Lancet"},{"key":"B50","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1097\/qco.0000000000000764","article-title":"Neonatal bloodstream infections","volume":"34","author":"Hadfield","year":"2021","journal-title":"Curr Opin Infect Dis"},{"key":"B51","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1038\/jp.2008.132","article-title":"Potential of immunomodulatory agents for prevention and treatment of neonatal sepsis","volume":"29","author":"Wynn","year":"2009","journal-title":"J Perinatol"},{"key":"B52","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1203\/01.Pdr.0000047471.47777.B0","article-title":"Antimicrobial polypeptides of human vernix caseosa and amniotic fluid: implications for newborn innate defense","volume":"53","author":"Yoshio","year":"2003","journal-title":"Pediatr Res"},{"key":"B53","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1002\/uog.9017","article-title":"Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial","volume":"38","author":"Hassan","year":"2011","journal-title":"Ultrasound Obstet Gynecol"},{"key":"B54","doi-asserted-by":"publisher","first-page":"105458","DOI":"10.1016\/j.compbiomed.2022.105458","article-title":"Machine learning in medical applications: a review of state-of-the-art methods","volume":"145","author":"Shehab","year":"2022","journal-title":"Comput Biol Med"},{"key":"B55","doi-asserted-by":"publisher","first-page":"100937","DOI":"10.1016\/j.imu.2022.100937","article-title":"Machine learning model for predicting the length of stay in the intensive care unit for COVID-19 patients in the eastern province of Saudi Arabia","volume":"30","author":"Alabbad","year":"2022","journal-title":"Inf Med Unlocked"},{"key":"B56","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.1016\/j.healun.2022.05.016","article-title":"Prolonged hospital length of stay after pediatric heart transplantation: a machine learning and logistic regression predictive model from the pediatric heart transplant society","volume":"41","author":"Gupta","year":"2022","journal-title":"J Heart Lung Transplant"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1121406\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T05:13:00Z","timestamp":1678684380000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1121406\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,13]]},"references-count":56,"alternative-id":["10.3389\/fped.2023.1121406"],"URL":"https:\/\/doi.org\/10.3389\/fped.2023.1121406","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,13]]},"article-number":"1121406"}}