Maternal factors, including social deprivation, results from a routine 36-week ultrasound scan, and labor/delivery data have been identified as independent predictors of prolonged neonatal intensive care unit (NICU) stay at term.
A retrospective analysis of a prospective cohort study involving 107,762 women with singleton pregnancies was conducted. The study spanned from March 2014 to November 2023 and examined various maternal factors, obstetric and medical history, pregnancy characteristics, and findings from the 36-week ultrasound scan, such as estimated fetal weight (EFW) and Doppler measurements.
Gestational age at delivery, mode of delivery, birth weight, and other outcomes were assessed, with the primary focus on prolonged NICU admission (> 2 days) for high-dependency or intensive care needs, such as total parenteral nutrition or invasive ventilation.
Among the singleton pregnancies studied, 0.88% resulted in neonates requiring NICU admission. Social deprivation, as measured by the Index of Multiple Deprivation (IMD), emerged as a significant predictor of prolonged NICU stay, surpassing ethnicity and other maternal factors.
The combined model incorporating maternal factors and data from the 36-week ultrasound scan revealed that fetal weight below the 10th percentile and above the 90th percentile were significant predictors of NICU admission risk.
Further analysis combining maternal factors, 36-week scan data, and delivery information successfully identified 39.1% of prolonged NICU admissions. However, more than 40% of these admissions remained unpredictable, underscoring the challenge of foreseeing NICU stays based on available variables.
The study’s authors emphasized the importance of integrating these findings into decision-making processes related to the birth setting, highlighting the necessity for continuous monitoring and access to skilled maternity care providers.
While the study shed light on key predictors of prolonged NICU admissions, it acknowledged limitations such as the reliance on area-based measures of social deprivation, which may not fully capture individual-level deprivation. Additionally, the absence of data on maternal mental health issues, medications, infections, and certain delivery methods was noted as a constraint.
Supported by a grant from the Fetal Medicine Foundation, the study was led by A. Arechvo from the Fetal Medicine Research Institute at King’s College Hospital in London, England. Published online in June 2025 in Ultrasound in Obstetrics & Gynecology, the research contributes valuable insights to the field of maternal and neonatal care.
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