Early hospital discharge of preterm very low birth weight infants

Abstract

Objective: The objective of this study was to investigate whether early discharge from the hospital was feasible for selected very low birth weight (VLBW) infants.

Study design: A randomized clinical trial of discharge of VLBW infants from the neonatal intensive care unit at 1300 gm versus 1800 gm was done comparing weight gain and incidence of infection. Forty-three VLBW infants treated in the neonatal intensive care unit and follow-up clinics of the Hospital Universitario del Valle, Cali, Colombia, were entered into the study at 1300 to 1350 gm when they met behavioral criteria for discharge and the family home was approved.

Results: There were no differences in weight gain or incidence of infection in the home group compared with the hospital group. A significant saving in hospital days and hospital costs was realized for the home group. Family cooperation was heightened in the home group.

Conclusions: Early discharge from the hospital at weights as low as 1300 to 1350 gm is safe for the VLBW infant when properly selected on the basis of behavioral criteria and environmental approval. The potential savings in hospital costs should be considered when resources are allocated for continued support for these infants.

PIP: It is traditional policy to delay the discharge of preterm infants from hospital nurseries until a predetermined weight (2000 g or more) has been achieved. However, prolonged hospitalization is associated with numerous adverse effects, including delayed mother-child bonding, reduced staff time for sick infants, an increased risk of nosocomial infections, and high costs. This study investigated the hypothesis that early hospital discharge is safe and feasible for very-low-birth-weight infants when behavioral and parental criteria, rather than achieved weight, serve as discharge indicators. Preterm infants from the Hospital Universitario del Valle in Calle, Colombia, were enrolled in the study at 1300-1350 g if they met the following criteria: maintenance of normal body temperature in an open crib, nippled feedings of at least 120 cal/kg/day, consistent weight gain for at least 3 days, asymptomatic and free of medications for at least 3 days, and a social worker-approved home environment (e.g., single-family home with utilities and phone, access to transportation, and parental willingness to participate in follow-up). 43 infants met these criteria; 27 were discharged and 16 were kept in the hospital. The duration of the hospital stay was 23.5 days for the home group and 42.5 days for the hospital group. 2 infants in the home group were readmitted to the hospital, 1 with diarrhea and 1 with pneumonia; 1 infant in the hospital group developed nosocomial Klebsiella aerobacter meningitis. There were no differences in weight gain or incidence of infection between the 2 groups and no infant deaths in the study period (up to 40 weeks of age). The parents of discharged infants kept all clinic appointments. These findings confirm the feasibility of this strategy and suggest that, in some very-low-birth-weight infants, behavioral development may be advanced even at weights as low as 1300-1400 g.