Early Discharge of Late-Preterm Infants: Risky, Yet Common

Dr Hirsch is a medical editor for Dr Pohl is professor of pediatrics and associate dean of student affairs and career counseling at Jefferson Medical College in Philadelphia.

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Discharge plans need to account for potential problems.

Excitement at the birth of a new baby and eagerness to begin life with baby at home often lead new parents to request an early discharge after delivery. When a mother, her obstetrician, and the pediatrician agree, discharge before 48 hours of life may be appropriate for a stable, healthy, term newborn without risk factors.However, for a late-preterm baby—even one without any evident complications—early discharge may be problematic, yet it appears to be common practice.

Late-preterm babies, defined as those born between 34 and 36 weeks’ gestation, are known to be at a higher risk for morbidity and mortality than full-term babies. They are more likely to have low blood sugar, respiratory problems, jaundice, feeding difficulties, temperature instability, and apnea.2 The American Academy of Pediatrics (AAP) states that these babies are usually not ready to leave the hospital before 48 hours of life and that when they are ready to go home, a follow-up appointment is needed within 24 to 48 hours after discharge.

To determine how well health care providers follow the AAP recommendations for late-preterm infants, Goyal and colleagues3 examined discharge data from all hospital births in California, Missouri, and Pennsylvania from 1993 to 2005. They included live newborns delivered vaginally at 34 to 36 weeks’ gestation anddefined early discharge as that which occurred before 2 nights in the hospital. Caesarean deliveries were excluded because those infants are usually discharged at least 72 hours after birth. Babies born to mothers who required more than 48 hours in the hospital were excluded, as were those with major congenital anomalies, surgeries, or complications (eg, sepsis and respiratory distress).

The Goyal study found that 51.4% of 282,601 late-preterm infants were discharged early. Between 1995 and 2000, early discharge rates decreased from 71% to 40%. However, by 2005, 10 years after the AAP’s discharge recommendations were first published, the rate still remained at 39%. Infants in California hospitals were significantly more likely to be discharged early, as were babies born in nonteaching hospitals who were uninsured or in an HMO.

As the authors state, the study is limited because it relies on administrative data to identify complications and comorbidities. In addition, further studies need to be done to determine whether late-preterm babies discharged early are at higher risk for morbidities or readmission than those who remain in the hospital. However, the Goyal study brings attention to an important fact: health care providers continue to discharge late-preterm infants early, despite the risk of multiple problems in this population.

Ideally, late-preterm infants should be observed closely for at least 48 hours and followed-up within 24 to 48 hours after discharge to identify any issues that arise. As research continues to highlight disparities between late-preterm and full-term infants, we need to have more respect for these differences and construct discharge plans accordingly. ■