Adherence to Discharge Guidelines for Late-Preterm Newborns

Babies born between 34 to 36 weeks’ gestation are being discharged early at stubbornly high rates in some regions and types of hospitals, despite mid-1990s care guidelines and insurance mandates to cover longer hospital stays.

Concerns that mothers and newborns were being sent home too soon to detect potentially dangerous postnatal health problems prompted the American Academy of Pediatricians to issue a 1995 policy statement on how long families should be hospitalized; it recommended babies born prior to 38 weeks should not be eligible for early discharge. Soon after, the federal government, as well as California, Missouri and Pennsylvania, required insurance plans to cover hospitalization for at least 48 hours after a full-term delivery. This first study of early discharge for late-preterm newborns (babies born between 34 to 36 weeks’ gestation) examined data related to 282,601 infants born from 1993 through 2005 at 611 hospitals in California, Missouri and Pennsylvania.

Key Findings:

  • The percentage of late-preterm babies being discharged early dramatically decreased from 71 percent in 1995 to 40 percent in 2000. However, in 2005, the percentage was still 40 percent.
  • California consistently had a significantly higher early discharge rate compared to Missouri and Pennsylvania. Even after adjustments for various factors, the difference remains notable, suggesting “an inherent, regional difference in newborn discharge decision-making.”
  • Although there was no difference between teaching versus non-teaching hospitals in fee-for-service patients, non-teaching hospitals were more likely to discharge babies early who were uninsured or on HMO plans.

The authors call for more research into why current care guidelines are not being followed, as well as into the repercussions of shorter hospitalizations for late-preterm babies and their mothers. Of particular concern is the apparent interaction between insurance type and hospital teaching status, and its impact on discharge timing.