Abstract

Background Preterm births contribute to approximately 35% of neonatal deaths globally, with an estimated 13.4 million infants born prematurely each year. Despite this substantial burden, limited evidence exists on time to discharge and its determinants among preterm neonates admitted to Neonatal Intensive Care Units (NICUs), particularly in rural Ugandan settings. This study aimed to investigate time to discharge and associated factors among preterm neonates admitted to Kiwoko Hospital in Nakaseke District, Uganda.

Methods A retrospective cohort study was conducted using secondary data from Kiwoko Hospital on preterm neonates admitted to the Neonatal Intensive Care Unit (NICU) between 2020 and 2021 (n = 847). The cumulative incidence function was used to estimate the probability of discharge within 28 days of admission, accounting for competing events. A Fine and Gray sub-distribution hazard regression model was fitted to identify factors associated with time to discharge.

Results Of the 847 preterm admissions, 70.1% were discharged alive within 28 days. The median time to discharge was 14 days. The cumulative incidence of discharge by 28 days was 68%, accounting for competing events. During follow-up, 165 neonates did not complete the 28-day period, including 88 deaths. Factors significantly associated with time to discharge included place of delivery (SHR: 0.62; 95% CI: 0.53–0.73; p<0.001), maternal residence in other districts (SHR: 0.69; 95% CI: 0.48–0.99; p=0.044), extreme preterm (SHR: 0.05; 95% CI: 0.03–0.09; p<0.001), very preterm (SHR: 0.18; 95% CI: 0.14–0.25; p<0.001), moderate preterm (SHR: 0.59; 95% CI: 0.46–0.76; p<0.001), triplet births (SHR: 0.40; 95% CI: 0.23–0.68; p=0.001), 2–4 ANC visits (SHR: 0.70; 95% CI: 0.56– 0.87; p=0.002), ≤1 ANC visit (SHR: 0.64; 95% CI: 0.49–0.85; p=0.002), respiratory distress syndrome (SHR: 0.64; 95% CI: 0.48–0.74; p<0.001), and birth trauma (SHR: 2.62; 95% CI: 1.60– 4.29; p<0.001).

Conclusions Respiratory distress syndrome, fewer antenatal care visits, out-of-district residence, and higher degrees of prematurity were associated with prolonged time to discharge among preterm neonates. Strengthening antenatal care utilization and improving access to quality neonatal care in underserved areas may enhance discharge outcomes.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study utilized secondary data following approval from the Ethics Committee of the School of Statistics and Planning at Makerere University. Permission to access data was granted by the Clinical Director of Kiwoko Hospital. The research protocols, including data collection methods, participant involvement, and ethical considerations, were reviewed and approved by the relevant institutional and/or licensing committees during the original data collection. Informed consent was obtained from all participants or their legal guardians as part of the initial data collection process. Given that this study involved secondary data, the requirement for additional informed consent was waived by the Ethics Committee of the School of Statistics and Planning at Makerere University, in line with national regulations. The study adhered to the ethical and consent procedures set by Kiwoko Hospital. All procedures followed in this research complied with the ethical standards established by relevant national and institutional committees for human research, as well as the Declaration of Helsinki (1975, amended in 2008). Strict confidentiality measures were implemented to protect patient information.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

The data used in this study were obtained from Kiwoko Hospital and are not publicly available due to institutional confidentiality policies. Access to the data can be requested from the corresponding author, subject to approval by the hospital and relevant ethical authorities.

AbbreviationsNICUsNeonatal Intensive Care UnitsNICUNeonatal Intensive Care UnitSHRSub-hazard RatioRDSPreterm respiratory distress syndromeWHOWorld Health OrganisationHIVHuman Immunodeficiency VirusELBWExtremely Low Birth WeightVLBWVery Low Birth WeightLBWLow Birth WeightKMCKangaroo Mother CareAPGARAppearance, Pulse, Grimace, Activity, and RespirationRefReference CategoryCIConfidence IntervalANCNumber of antenatal careANCMaternal antenatal careSDGSustainable Development Goal