Variation in Discharge Timing

To the Editor.—

We were pleased to see the article by Eichenwald et al ¹ on variation in discharge timing. We recently published variation on discharge by day of the week and agree that variation exists and matters. ² Individual practitioner variation may be even a bigger influence than institution-specific variation. This article continues the clarion call for widely accepted discharge guidelines.

Although we commend Eichenwald et al for examining their discharge practices, several issues are worth commenting on. In particular, the use of the phrase “margin of safety,” defined as “the number of elapsed days until discharge after infants were first documented to have reached physiologic maturity,” causes some concern.

The concept of observation after reaching physiologic maturity is generally accepted in neonatology, although the ideal duration has not been established. Previously we demonstrated in a controlled, randomized trial ³ that “accelerated discharge” could successfully take place without reaching physiologic maturity, defined by Eichenwald as “maintaining temperature in open crib, being free of …