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Adherence to discharge guidelines for late-preterm newborns

Neera K Goyal1, Corinne Fager, Scott A Lorch

  • 1Robert Wood Johnson Foundation Clinical Scholars, University of Pennsylvania, 423 Guardian Dr, 1310 Blockley Hall, Philadelphia, PA 19104, USA. goyaln@email.chop.edu

Pediatrics
|June 22, 2011
PubMed

Insights

Early discharge for late-preterm newborns decreased in the late 1990s but remains common. Hospital characteristics and state influence early discharge decisions, necessitating further safety research.

Area of Science:

  • Neonatal care
  • Pediatric hospital discharge practices
  • Public health policy

Background:

  • Late-preterm newborns (34-36 weeks gestation) have unique care needs.
  • Early discharge practices for these infants may pose risks.
  • Adherence to American Academy of Pediatrics (AAP) guidelines for early discharge is variable.

Purpose of the Study:

  • To analyze trends in early discharge of late-preterm infants.
  • To investigate the relationship between hospital characteristics and early discharge rates.
  • To identify factors associated with deviations from AAP recommendations.

Main Methods:

  • Population-based cohort study utilizing birth certificate and hospital discharge data.
  • Inclusion of 282,601 late-preterm newborns across 611 hospitals in California, Missouri, and Pennsylvania (1993-2005).
  • Logistic regression analysis to assess associations between early discharge and hospital/patient factors, adjusting for covariates.

Main Results:

  • Early discharge rates declined from 71% (1995) to 40% (2000) but remained at 39% in 2005.
  • California and Missouri showed higher odds of early discharge compared to Pennsylvania.
  • Nonteaching hospitals were more likely to discharge uninsured or HMO-enrolled infants early.

Conclusions:

  • Early discharge of late-preterm newborns persists despite a past decline.
  • Significant variations in early discharge exist based on state, hospital teaching status, and insurance type.
  • Further research is crucial to determine the safety and appropriateness of early discharge for this vulnerable infant population.
Abstract

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