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How much does a minimum weight at discharge delay discharge from the neonatal intensive care unit?
R K Desai1, M Bhola2,3, S Ronis3,4
1Division of Neonatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Insights
Discharging physiologically mature infants regardless of weight could reduce hospital stays by 0.55-2.6 days. This is particularly beneficial for small for gestational age infants, potentially saving 50 hospital days.
Area of Science:
- Neonatal care
- Pediatric hospital policy
- Infant discharge criteria
Background:
- Current American Academy of Pediatrics guidelines advocate for discharge at physiologic maturity (PM), irrespective of infant weight.
- Our institution's neonatal intensive care unit (NICU) policy mandates a minimum weight of 1800 grams for discharge, even for physiologically mature infants.
- This discrepancy prompted an investigation into the impact of adhering to national guidelines on hospital length of stay.
Purpose of the Study:
- To evaluate whether discharging infants at physiologic maturity (PM), as recommended by national guidelines, would reduce hospital days (HD).
- To assess the potential reduction in hospital length of stay by removing the minimum weight requirement for discharge.
Main Methods:
- A retrospective review was conducted on 129 infants with birth weights between 1300 and 1800 grams.
- Data analysis involved paired t-tests and Wilcoxon-rank-sum tests to compare age at discharge and age at physiologic maturity.
Main Results:
- Infants were discharged an average of 0.55 days after reaching physiologic maturity, resulting in 71 total potentially avoidable hospital days.
- This difference was more pronounced in small for gestational age (SGA) infants (1.47 days) compared to non-SGA infants (0.19 days).
- Infants reaching PM before 1800 grams experienced an average delay of 2.63 days in discharge, accounting for 50 of the 71 potentially saved hospital days.
Conclusions:
- A 0.55 to 2.6-day difference exists between actual discharge age and age at physiologic maturity, with greater delays observed in SGA infants and those reaching PM below 1800 grams.
- Revising the NICU policy to align with national guidelines, by removing the minimum weight requirement, could lead to earlier infant discharge.
- Earlier discharge opportunities may exist for infants who are physiologically mature, allowing them to transition home to their families sooner.
Background:
Current American Academy of Pediatrics guidelines recommend discharge at physiologic maturity regardless of weight; however, our institution's neonatal ICU policy requires a minimum weight of 1800 g for discharge even when infant is physiologically mature. So, we wanted to determine if discharge at physiologic maturity (PM), based on national guidelines, would decrease hospital days (HD).
Methods:
We reviewed 129 infants with birthweight 1300g- 1800 g. Data were analyzed by paired t-test/ Wilcoxon-rank-sum test.
Results:
Age at discharge vs. age at PM was 0.55d per infant higher (P-value 0.033) resulting in 71 total HD. For SGA babies, this difference was 1.47d vs 0.19d in non-SGA babies (P- value 0.0243) and this difference was an average of 2.63d (P-value < 0.001) for those who reached PM < 1800 g, contributing to 50 of 71 HD potentially saved.
Conclusion:
There was a 0.55-2.6-day difference between age at discharge and age at PM, greater in SGA infants and infants who reached PM prior to 1800 g. There might be an opportunity to send infants home earlier to their families if there is no minimum weight required.
