Related Experiment Video
Updated: Jul 29, 2026
A Swine Model of Neonatal Asphyxia
Published on: October 11, 2011
Inter-neonatal intensive care unit variation in discharge timing: influence of apnea and feeding management
E C Eichenwald1, M Blackwell, J S Lloyd
1Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. eeichenwald@partners.org
Insights
Neonatal intensive care units (NICUs) show significant variation in discharge timing for healthy premature infants. Differences in monitoring and documenting apnea of prematurity and feeding readiness likely contribute to these length of stay disparities.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
Background:
- Premature infants require medical stability and maturational milestones for safe home discharge.
- Current practice includes a post-maturity observation period (margin of safety) before discharge.
Purpose of the Study:
- To compare postmenstrual age (PMA) at discharge for premature infants across different NICUs.
- To assess how recognition of physiologic maturity and safety margins impact hospital stay.
Main Methods:
- Retrospective review of 435 healthy premature infants (30-34 6/7 weeks gestational age) from 15 Massachusetts NICUs.
- Data collected on gestational age, birth weight, and discharge parameters.
Main Results:
- Infants were discharged at similar postmenstrual ages irrespective of gestational age at birth.
- Significant variation in PMA at discharge was observed between NICUs (35.2 to 36.5 weeks).
- Later discharge correlated with older recorded ages for cardiorespiratory and feeding maturity; longer pulse oximetry use linked to later apnea resolution.
Conclusions:
- Wide variations exist in hospital length of stay for healthy premature infants across NICUs.
- Differences in apnea monitoring/documentation and feeding behavior assessment may explain length of stay disparities.
Background:
Premature infants need to attain both medical stability and maturational milestones (specifically, independent thermoregulation, resolution of apnea of prematurity, and the ability to feed by mouth) before safe discharge to home. Current practice also requires premature infants to be observed in hospital before discharge for several days (margin of safety) after physiologic maturity is recognized.
Objective:
To compare postmenstrual age (PMA) at discharge in a homogeneous population of premature infants cared for in different neonatal intensive care units (NICUs) and to assess the impact on hospital stay of the recognition and recording of physiologic maturity and the required margin of safety.
Methods:
We studied premature infants delivered at 30 to 34 6/7 weeks gestational age (GA), free of significant medical or surgical complications. Medical records of 30 eligible infants consecutively discharged from the hospital before July 1997 from each of 15 NICUs in Massachusetts (9 level 2 and 6 level 3) were reviewed.
Results:
A total of 435 infants were included in the study sample. Mean (+/- standard deviation) GA and birth weight of the study population were 33.2 +/- 1.2 weeks and 2024 +/- 389 g, respectively. Infants were discharged at a similar PMA regardless of GA at birth. Considerable variation in the PMA at discharge between hospital sites was observed (range, 35.2 +/- 0.5 weeks to 36.5 +/- 1.2 weeks). Despite the homogeneous study population, hospitals in which infants had the latest PMA at discharge also recorded mature cardiorespiratory and feeding behavior at an older age. Longer duration of pulse oximetry use was associated with later resolution of apnea. Differences in the duration of the margin of safety between sites did not contribute to variation in hospital stay.
Conclusion:
NICUs vary widely in length of hospital stay for healthy premature infants. We speculate that this variation results in part from differences in monitoring for and documentation of apnea of prematurity and feeding behavior.
More Related Videos
Related Concept Videos
01:21Planning Nursing Care I
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:22Aneurysm IV: Nursing Management