Length of stay and its associated factors in the neonatal intensive care unit of Gadarif Hospital, Eastern Sudan: a retrospective study

Background: Attention is increasingly paid to length of stay (LOS) in neonatal intensive care units (NICUs) across countries. Few published data on neonatal LOS exist in Africa, where there is a high burden of neonatal morbidity and mortality. Thus, this study investigated the factors associated with neonatal LOS in the NICU of Gadarif Hospital, Eastern Sudan.

Methods: A hospital-based retrospective study was conducted at Gadarif Hospital in Eastern Sudan from May to December 2020. Sociodemographic, maternal, and neonatal data were obtained from the hospital records. Poisson regressions were used to determine the adjusted relative risk (aRR) values and 95.0% confidence intervals (CIs).

Results: This study enrolled 333 neonates admitted to the NICU and discharged alive. The median (interquartile range [IQR]) of maternal age and parity was 27.0 (23.0‒30.0) years and 3 (2‒5), respectively. Of the 333 neonates, 160 (48.0%) were males; 136 (40.8%) were delivered via cesarean section; 258 (77.5%) had low Apgar scores, and 74 (22.2%) had birth asphyxia. There were 140 (42.0%) low birth weight (LBW) neonates and 133 (39.9%) preterm neonates. The LOS range was 1-29 days (mean = 5.1 days), and its median (IQR) was 4 (2‒7) days. The multivariate Poisson analysis showed that increasing maternal age (aRR = 1.02, 95% CI = 1.01‒1.05), LBW (aRR = 1.48, 95% CI = 1.16‒1.90), preterm delivery (aRR = 1.27, 95% CI = 1.01‒1.61), a low Apgar score (aRR = 1.32, 95% CI = 1.06‒1.42), and an increasing white blood cell (WBC) count (aRR = 1.001, 95% CI = 1.001‒1.002) were associated with LOS. Parity (aRR = 0.85, 95% CI = 0.80‒0.91) was inversely associated with LOS. However, neonatal jaundice and mode of delivery were associated with LOS only in the univariate analysis.

Conclusion: Increasing maternal age, preterm newborn, LBW, and a low Apgar score prolonged the LOS in this region of Sudan. Healthcare providers could leverage these identified factors to predict extended neonatal LOS in Eastern Sudan, enabling proactive interventions to enhance neonatal outcomes.