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Early Discharge of Very Preterm Infants Is Not Associated with Impaired Growth up to Three Months Postmenstrual Age:
Rahel Schuler1,2, Vanessa Bethke1, Viola Schmidt1
1Department of General Pediatrics and Neonatology, Justus-Liebig-University, Feulgenstrasse 12, D-35392 Giessen, Germany.
Insights
Early discharge for preterm infants under family-centered care (FCC) did not negatively impact growth up to three months postmenstrual age (PMA). This suggests early discharge is a safe practice for preterm infant growth outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Growth and Development
- Family-Centered Care
Background:
- Postnatal growth restriction and prolonged hospital stays are risks for preterm infant neurodevelopment.
- Family-centered care (FCC) programs can reduce hospital length of stay for preterm infants.
Purpose of the Study:
- To evaluate the impact of earlier hospital discharge on the growth of preterm infants up to three months postmenstrual age (PMA).
Main Methods:
- Prospective, single-center cohort study in a German level III neonatal unit (October 2020-November 2023).
- Included 184 preterm infants across six cohorts with progressive FCC implementation.
- Analyzed growth parameters (weight, length, head circumference) at discharge, term-equivalent age (TEA), and three months PMA.
Main Results:
- Postmenstrual age (PMA) at discharge significantly decreased with FCC implementation (37.8 ± 2.1 to 35.7 ± 0.91 weeks).
- Infants in later FCC cohorts showed lower absolute weight, length, and head circumference at discharge, but Z-scores did not differ significantly.
- No significant differences in growth outcomes or Z-score changes were observed at TEA or three months PMA.
Conclusions:
- Early discharge facilitated by FCC does not adversely affect preterm infant growth up to three months PMA.
- Early discharge appears to be a safe practice concerning growth outcomes in preterm infants.
- Further multicenter randomized trials are recommended to validate these findings.
Abstract:
Background/Objectives: Postnatal growth restriction and duration of hospital stay have been identified as risk factors for adverse neurodevelopment in preterm infants. Implementation of a family-centered care (FCC) program in our institution reduced length of stay in preterm infants. This study evaluates the effect of more early discharge on growth up to three months postmenstrual age (PMA). Methods: We conducted a prospective, single-center cohort study in a German level III neonatal unit (October 2020-November 2023) including six consecutive cohorts (n = 184) with progressive FCC implementation. This secondary analysis examined growth at discharge, term-equivalent age (TEA), and three months PMA. Results: PMA at discharge significantly decreased from the baseline to intervention cohort 5 (37.8 ± 2.1 vs. 35.7 ± 0.91 weeks PMA; p = 0.03). Compared to the baseline cohort, infants in intervention cohort 5 had significantly lower weight, length, and head circumference at discharge. However corresponding Z-Scores did not differ significantly between the cohorts. No significant differences in growth outcomes were observed at TEA or at three months PMA. Furthermore, there were no significant differences in the change in Z-Score for weight, length, and HC from birth to three months PMA. Conclusions: Early discharge under FCC did not impair growth to three months PMA, suggesting that early discharge is a safe practice with respect to growth outcomes in preterm infants. Further randomized multicenter studies are needed to confirm these results.
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