Document Detail

Inter-neonatal intensive care unit variation in discharge timing: influence of apnea and feeding management.
MedLine Citation:
PMID:  11581446     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Premature infants need to attain both medical stability and maturational milestones (specifically, independent thermoregulation, resolution of apnea of prematurity, and the ability to feed by mouth) before safe discharge to home. Current practice also requires premature infants to be observed in hospital before discharge for several days (margin of safety) after physiologic maturity is recognized. OBJECTIVE: To compare postmenstrual age (PMA) at discharge in a homogeneous population of premature infants cared for in different neonatal intensive care units (NICUs) and to assess the impact on hospital stay of the recognition and recording of physiologic maturity and the required margin of safety. METHODS: We studied premature infants delivered at 30 to 34 6/7 weeks gestational age (GA), free of significant medical or surgical complications. Medical records of 30 eligible infants consecutively discharged from the hospital before July 1997 from each of 15 NICUs in Massachusetts (9 level 2 and 6 level 3) were reviewed. RESULTS: A total of 435 infants were included in the study sample. Mean (+/- standard deviation) GA and birth weight of the study population were 33.2 +/- 1.2 weeks and 2024 +/- 389 g, respectively. Infants were discharged at a similar PMA regardless of GA at birth. Considerable variation in the PMA at discharge between hospital sites was observed (range, 35.2 +/- 0.5 weeks to 36.5 +/- 1.2 weeks). Despite the homogeneous study population, hospitals in which infants had the latest PMA at discharge also recorded mature cardiorespiratory and feeding behavior at an older age. Longer duration of pulse oximetry use was associated with later resolution of apnea. Differences in the duration of the margin of safety between sites did not contribute to variation in hospital stay. CONCLUSION: NICUs vary widely in length of hospital stay for healthy premature infants. We speculate that this variation results in part from differences in monitoring for and documentation of apnea of prematurity and feeding behavior.
E C Eichenwald; M Blackwell; J S Lloyd; T Tran; R E Wilker; D K Richardson
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatrics     Volume:  108     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2001 Oct 
Date Detail:
Created Date:  2001-10-02     Completed Date:  2002-01-03     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  928-33     Citation Subset:  AIM; IM    
Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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MeSH Terms
Age Factors
Apnea / diagnosis,  therapy
Birth Weight
Body Temperature Regulation / physiology
Bradycardia / diagnosis,  therapy
Child Development / physiology
Feeding Behavior / physiology*
Gestational Age
Infant Food
Infant Nutritional Physiological Phenomena / physiology*
Infant, Newborn
Infant, Premature / growth & development*
Infant, Premature, Diseases / diagnosis,  therapy
Intensive Care Units, Neonatal / statistics & numerical data*
Length of Stay / statistics & numerical data*
Patient Discharge / statistics & numerical data*
Comment In:
Pediatrics. 2002 Aug;110(2 Pt 1):423-4; author reply 423-4   [PMID:  12165612 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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