Early discharge among late preterm and term newborns and risk of neonatal morbidity.

Full Abstract

Understanding how late preterm infants (34-36 completed weeks' gestation) are affected by discharge policies created for term infants (37-41 completed weeks' gestation) is essential for preventing postdischarge neonatal morbidity among late preterm infants. We analyzed linked birth certificate and hospital discharge data for Massachusetts between 1998 and 2002 to evaluate the risk of neonatal morbidity (defined as hospital readmission, observational stay, or both) between all vaginally delivered, live-born singleton late preterm and term infants. All infants were born at a Massachusetts hospital to a state resident and were discharged home early (<2-night hospital stay). We calculated crude and adjusted risk ratios using a modified Poisson regression and compared the timing and principal discharge diagnoses for those neonates who needed hospital readmission. Of the 1004 late preterm and 24,320 term infants in our study, 4.3% and 2.7% of infants, respectively, were either readmitted or had an observational stay. Late preterm infants were 1.5 times more likely to require hospital-related care and 1.8 times more likely to be readmitted than term infants. Among infants who were breastfed, late preterm infants were 1.8 times more likely than term infants to require hospital-related care and 2.2 times more likely to be readmitted. In contrast, no differences were found between late preterm and term infants who were not breastfed. Jaundice and infection accounted for the majority of readmissions. Our findings suggest that late preterm infants discharged early experience significantly more neonatal morbidity than term infants discharged early; however, this may be true only for breastfed infants. Evidence-based recommendations for appropriate discharge timing and postdischarge follow-up for these late preterm infants are needed to prevent neonatal morbidity.

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Author information

Author/s: Tomashek, Kay M (KM); Shapiro-Mendoza, Carrie K (CK); Weiss, Judith (J); Kotelchuck, Milton (M); Barfield, Wanda (W); Evans, Stephen (S); Naninni, Angela (A); Declercq, Eugene (E);

Affiliation: Centers for Disease Control and Prevention, Division of Reproductive Health, Maternal and Infant Health Branch, Atlanta, GA 30341, USA. kct9(-atsign-)cdc.gov

Journal and publication information

Publication Type: Journal Article

Journal: Seminars in perinatology (Semin Perinatol), published in United States. (Language: eng)

Reference: 2006-Apr; vol 30 (issue 2) : pp 61-8

Dates: Created 2006/05/29; Completed 2006/10/26;

PMID: 16731278, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Birth Weight
Breast Feeding - epidemiology
Cohort Studies
Educational Status
Female
Gestational Age
Humans
Infant, Newborn
Infant, Newborn, Diseases - epidemiology
Infant, Premature

Infant, Premature, Diseases - epidemiology
Jaundice, Neonatal - epidemiology
Male
Massachusetts - epidemiology
Middle Aged
Nurseries, Hospital - utilization
Patient Discharge - statistics & numerical data
Patient Readmission - statistics & numerical data
Poisson Distribution
Postnatal Care - statistics & numerical data
Pregnancy

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