Despite recommendations against it, early discharge of late-preterm newborns remains common
Like King Canute of England ordering the tides to stop, professional medical societies can issue guidelines to spread the use of best practices, but will practitioners and patients listen? A new study of early hospital discharges of late-preterm (LP) newborns in 3 States over 10 years suggests that many will but some may not. Early hospital discharge (less than 48 hours after birth) for LP infants (delivered vaginally and born live at 34–36 weeks' gestation) is a practice advised against by the American Academy of Pediatrics (AAP). That's because these newborns are at higher risk of neonatal complications.
The researchers found that 51.4 percent of 282,601 LP newborns in the study were discharged early. From 1995, when the AAP first issued a policy statement about early discharge for LP newborns, to 2000, the early discharge rate declined from 71 percent to 44 percent. This decline tapered off thereafter, so that by 2005 the rate of early discharges for these newborns had only reached 40 percent. The time trends were similar between teaching and nonteaching hospitals in the study, although the percentage of early discharges at teaching hospitals was lower.
The researchers studied LP births from 611 hospitals in California, Pennsylvania, and Missouri. In unadjusted analysis, Hispanic ethnicity, lack of insurance, and California residence were associated with early discharge. LP newborns whose mothers were under 20 years old were 22 percent more likely to be discharged early than those whose mothers were 20–35 years old, while those with mothers over age 35 were 26 percent less likely to have early discharge.
Newborns whose mothers had previous children were 18 percent more likely to be discharged early. Black newborns were 20 percent less likely than white newborns to be discharged early. Rural hospitals and isolated rural locations were more likely (58 and 81 percent, respectively) to discharge LP newborns early than were urban hospitals. The study was funded in part by the Agency for Healthcare Research and Quality (HS15696).
More details are in "Adherence to discharge guidelines for late-preterm newborns" by Neera K. Goyal, M.D., Corinne Fager, M.S., and Scott A. Lorch, M.D., M.S.C.E., in the July 2011 Pediatrics 128(1), pp. 62-71.
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