Earlier Discharge With Community-Based Intervention for Low Birth Weight Infants: A Randomized Trial

¹ From the Newborn Follow-up Program, Children's Hospital of Winnipeg, and the Department of Pediatrics and Section of Neonatology, Health Sciences Centre, Winnipeg, Canada
² From the Maternal and Child Health Directorate, Manitoba Health, Winnipeg, Canada
³ From the Homemaker Program, Family Services of Winnipeg Inc; Winnipeg, Canada
⁴ From the Department of Pediatrics, University of Manitoba, Winnipeg, Canada
⁵ From the Department of Pediatrics, University of Manitoba and Section of Neonatology, Health Sciences Centre, Winnipeg, Canada
⁶ From the Department of Pediatrics, University of Manitoba and the Section of Neonatology, St Boniface General Hospital, Winnipeg, Canada
⁷ From the Department of Pediatrics and Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
⁸ From the Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada

Background. Prolonged hospitalization of low birth weight infants increases the risk of medical and psychosocial complications. The feasibility of earlier discharge with community-based follow-up of infants of 2000 g birth weight, without the use of home apnea monitors, was investigated.

Methods. One hundred infants of 2000 g birth weight were randomized to either an intervention or control group. Intervention infants were discharged when readiness criteria were met. Based on assessed need, intervention group families received public health nursing and homemaker services for up to 8 weeks. Control infants were discharged to their homes at the discretion of the attending physician. All infants were assessed blindly at age 1 year with the Bayley and Home Observation for Measurement of the Environment (HOME) scales.

Results. There were no group differences in baseline infants' characteristics or in neonatal complications. Infants in the intervention group were discharged from the hospital at an earlier postconceptional age (mean ± SD 36.6 ± 1.5 weeks vs 37.3 ± 1.6 weeks; P < .04). Median length of hospital stay (23 days vs 31.5 days) and mean weight at the time of discharge (2200 ± 288 g vs 2275 ± 301 g) were lower, but not significantly, for infants in the intervention group. A secondary analysis by birth weight strata (1500 g and 1501 through 2000 g) revealed that the most significant reductions in hospital stay and weight at discharge were realized in infants of 1501 through 2000 g birth weight The persistence of apneic episodes and need for electronic monitoring prevented earlier discharge of infants of 1500 g birth weight. Postdischarge services to the intervention group included 185 public health nurse home visits (3.8 ± 0.91), 410 phone contacts (8.4 ± 5), and 2298 homemaker hours (46 ± 78) of service. At 1 year, there were no deaths and no group differences in rehospitalization rates, use of ambulatory services, or Bayley scores. Intervention families had significantly higher 1-year HOME scores. Minimum cost of hospital care was $873 per day, while the total cost of community-based services averaged $626 per infant.

Conclusions. A significant reduction in average length of hospital stay was achieved for infants of 1501 through 2000 g birth weight. Earlier discharge of infants weighing 1500 g at birth was hampered by persistent apneic episodes and feeding difficulties. A community-based program designed to provide individualized support and education for families of low birth weight infants was cost-effective and had a positive influence on the home environment.

Key Words: premature newborn • low birth weight • neonatal intensive care • length of stay • patient discharge • home care services • follow-up studies • child development • cost-benefit analysis • community health • family support

Submitted on September 11, 1992
Accepted on February 22, 1993

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