How much does a minimum weight at discharge delay discharge from the neonatal intensive care unit?

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.