Download PDF
Am J Perinatol 2021; 38(08): 773-778
DOI: 10.1055/s-0039-3401850
Original Article

When is My Baby Going Home? Moderate to Late Preterm Infants are Discharged at 36 Weeks Based on Admission Data

Alanna Higgins Joyce
1   Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Arnab Sengupta
2   Department of Pediatrics, Mercy Hospital, Springfield, Miami
,
Craig F. Garfield
1   Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Patrick Myers
1   Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective This study evaluates the effect of admission characteristics of uncomplicated moderate to late preterm infants on timing of discharge. One of the first questions that families of infants admitted to the Neonatal Intensive Care Unit (NICU) ask is, “When is my baby going home?” Moderate to late preterm infants are the largest cohort of NICU patients but little data exist about their length of stay (LOS).

Study Design A retrospective electronic chart review was completed on 12,498 infants admitted to our NICU between January 1, 2009 and December 31, 2015. All inborn infants with a gestational age between 320/7 and 366/7 weeks were studied.

Results A total of 3,240 infants met our inclusion criteria. The mean postmenstrual age at discharge was 363/7 weeks. Infants who were small for gestational age were significantly more likely to have an increased LOS. Infants born between 34 and 366/7 weeks had a significantly increased LOS if they had respiratory distress syndrome. Admission diagnoses of neonatal abstinence syndrome, meconium aspiration syndrome, hydrops, hypoxic ischemic encephalopathy, biliary emesis, ABO incompatibly, and a genetic diagnosis all had increased LOS for all late preterm infants.

Conclusion For uncomplicated moderate to late preterm infants, clinicians can counsel families that their infants will likely be discharged at 36 weeks of postmenstrual age. Small for gestational age infants and those with specific diagnoses may stay longer.

Keywords

prematurity - length of stay - discharge - families - communication


Publication History

Received: 15 April 2019

Accepted: 11 November 2019

Article published online:
30 December 2019

© 2019. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2017. Natl Vital Stat Rep 2018; 67 (08) 1-50
    PubMedGoogle Scholar
  • 2 Harrison W, Goodman D. epidemiologic trends in neonatal intensive care, 2007-2012. JAMA Pediatr 2015; 169 (09) 855-862
    CrossrefPubMedGoogle Scholar
  • 3 Grosse SD, Waitzman NJ, Yang N, Abe K, Barfield WD. Employer-sponsored plan expenditures for infants born preterm. Pediatrics 2017; 140 (04) 10
    CrossrefPubMedGoogle Scholar
  • 4 Behrman RE, Butler AS. Preterm Birth: Causes, Consequences, and Prevention. Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Washington, DC: National Academies Press (US); 2007
    Google Scholar
  • 5 Garfield CF, Lee Y, Kim HN. Paternal and maternal concerns for their very low-birth-weight infants transitioning from the NICU to home. J Perinat Neonatal Nurs 2014; 28 (04) 305-312
    CrossrefPubMedGoogle Scholar
  • 6 Escobar GJ, Greene JD, Hulac P. et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gestations. Arch Dis Child 2005; 90 (02) 125-131
    CrossrefPubMedGoogle Scholar
  • 7 Edwards EM, Horbar JD. Variation in use by NICU types in the United States. Pediatrics 2018; 142 (05) e20180457
    CrossrefPubMedGoogle Scholar
  • 8 Engle WA, Tomashek KM, Wallman C. Committee on Fetus and Newborn, American Academy of Pediatrics. “Late-preterm” infants: a population at risk. Pediatrics 2007; 120 (06) 1390-1401
    CrossrefPubMedGoogle Scholar
  • 9 Shapiro-Mendoza C. Infants born late preterm: epidemiology, trends, and morbidity risk. Neoreviews 2009; 10 (06) 287-294
    CrossrefPubMedGoogle Scholar
  • 10 Kramer MS, Demissie K, Yang H, Platt RW, Sauvé R, Liston R. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. The contribution of mild and moderate preterm birth to infant mortality. JAMA 2000; 284 (07) 843-849
    CrossrefPubMedGoogle Scholar
  • 11 McLaurin KK, Hall CB, Jackson EA, Owens OV, Mahadevia PJ. Persistence of morbidity and cost differences between late-preterm and term infants during the first year of life. Pediatrics 2009; 123 (02) 653-659
    CrossrefPubMedGoogle Scholar
  • 12 Rogowski J. Measuring the cost of neonatal and perinatal care. Pediatrics 1999; 103 (1, Suppl E): 329-335
    CrossrefPubMedGoogle Scholar
  • 13 Ogata JF, Fonseca MC, Miyoshi MH, Almeida MF, Guinsburg R. Costs of hospitalization in preterm infants: impact of antenatal steroid therapy. J Pediatr (Rio J) 2016; 92 (01) 24-31
    CrossrefPubMedGoogle Scholar
  • 14 Bender GJ, Koestler D, Ombao H. et al. Neonatal intensive care unit: predictive models for length of stay. J Perinatol 2013; 33 (02) 147-153
    CrossrefPubMedGoogle Scholar
  • 15 Hintz SR, Bann CM, Ambalavanan N, Cotten CM, Das A, Higgins RD. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Predicting time to hospital discharge for extremely preterm infants. Pediatrics 2010; 125 (01) e146-e154
    CrossrefPubMedGoogle Scholar
  • 16 Seaton SE, Barker L, Jenkins D, Draper ES, Abrams KR, Manktelow BN. What factors predict length of stay in a neonatal unit: a systematic review. BMJ Open 2016; 6 (10) e010466
    CrossrefPubMedGoogle Scholar
  • 17 Eichenwald EC, Blackwell M, Lloyd JS, Tran T, Wilker RE, Richardson DK. Inter-neonatal intensive care unit variation in discharge timing: influence of apnea and feeding management. Pediatrics 2001; 108 (04) 928-933
    CrossrefPubMedGoogle Scholar
  • 18 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
    CrossrefPubMedGoogle Scholar
  • 19 Raines DA. Mothers' stressor as the day of discharge from the NICU approaches. Adv Neonatal Care 2013; 13 (03) 181-187
    CrossrefPubMedGoogle Scholar
  • 20 Garfield CF, Lee YS, Kim HN. et al. supporting parents of premature infants transitioning from the NICU to home: a pilot randomized control trial of a smartphone application. Internet Interv 2016; 4 (Pt 2): 131-137
    CrossrefPubMedGoogle Scholar
  • 21 Powell PJ, Powell CV, Hollis S, Robinson MJ. When will my baby go home?. Arch Dis Child 1992; 67 (10 Spec No): 1214-1216
    CrossrefPubMedGoogle Scholar
  • 22 Phibbs CS, Schmitt SK. Estimates of the cost and length of stay changes that can be attributed to one-week increases in gestational age for premature infants. Early Hum Dev 2006; 82 (02) 85-95
    CrossrefPubMedGoogle Scholar
  • 23 Panagl A, Kohlhauser C, Pollak A. [Integrated psychological parental assistance in the neonatal intensive care unit: concepts and first experiences]. Z Geburtshilfe Neonatol 2005; 209 (01) 14-21
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Turner M, Winefield H, Chur-Hansen A. The emotional experiences and supports for parents with babies in a neonatal nursery. Adv Neonatal Care 2013; 13 (06) 438-446
    CrossrefPubMedGoogle Scholar
  • 25 Raines DA. Preparing for NICU discharge: mothers' concerns. Neonatal Netw 2013; 32 (06) 399-403
    CrossrefPubMedGoogle Scholar
  • 26 Purdy IB, Craig JW, Zeanah P. NICU discharge planning and beyond: recommendations for parent psychosocial support. J Perinatol 2015; 35 (Suppl. 01) S24-S28
    CrossrefPubMedGoogle Scholar
  • 27 Pulver LS, Guest-Warnick G, Stoddard GJ, Byington CL, Young PC. Weight for gestational age affects the mortality of late preterm infants. Pediatrics 2009; 123 (06) e1072-e1077
    CrossrefPubMedGoogle Scholar
  • 28 Lee HC, Bennett MV, Schulman J, Gould JB, Profit J. Estimating length of stay by patient type in the neonatal intensive care unit. Am J Perinatol 2016; 33 (08) 751-757
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Touch SM, Greenspan JS, Kornhauser MS, O'Connor JP, Nash DB, Spitzer AR. The timing of neonatal discharge: an example of unwarranted variation?. Pediatrics 2001; 107 (01) 73-77
    CrossrefPubMedGoogle Scholar