EARLIER DISCHARGE WITH COMMUNITY-BASED INTERVENTION FOR LOW-BIRTH-WEIGHT INFANTS - A RANDOMIZED TRIAL

Background. Prolonged hospitalization of low birth weight infants incr eases the risk of medical and psychosocial complications. The feasibil ity of earlier discharge with community-based follow-up of infants of less-than-or-equal-to 2000 g birth weight, without the use of home apn ea monitors, was investigated. Methods. One hundred infants of less-th an-or-equal-to 2000 g birth weight were randomized to either an interv ention or control group. Intervention infants were discharged when rea diness criteria were met. Based on assessed need, intervention group f amilies received public health nursing and homemaker services for up t o 8 weeks. Control infants were discharged to their homes at the discr etion of the attending physician. All infants were assessed blindly at age 1 year with the Bayley and Home Observation for Measurement of th e Environment (HOME) scales. Results. There were no group differences in baseline infants' characteristics or in neonatal complications. Inf ants 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 2 275 +/- 301 g) were lower, but not significantly, for infants in the i ntervention group. A secondary analysis by birth weight strata (less-t han-or-equal-to 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 persisten ce of apneic episodes and need for electronic monitoring prevented ear lier discharge of infants of less-than-or-equal-to1500 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 w ere no deaths and no group differences in rehospitalization rates, use of ambulatory services, or Bayley scores. Intervention families had s ignificantly higher 1-year HOME scores. Minimum cost of hospital care was $873 per day, while the total cost of community-based services ave raged $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 less-than-or-eq ual-to 1500 g at birth was hampered by persistent apneic episodes and feeding difficulties. A community-based program designed to provide in dividualized support and education for families of low birth weight in fants was cost-effective and had a positive influence on the home envi ronment.