296 Earlier Discharge for Moderately Premature Infants at Kaiser Permanente in California

Abstract

Objective: To compare gestational age at discharge between infants born at 30 to 34 6/7 weeks gestational age who were admitted to neonatal intensive care units (NICUs) in California, Massachusetts and the United Kingdom (UK).Design: Prospective observational cohort study.Setting: 54 UK, 5 California and 5 Massachusetts NICUs.Subjects: 4359 infants who survived to discharge home following admission to a NICU.Main outcome measures: Gestational age at discharge homeResults: The mean (standard deviation) postmenstrual age at discharge of the infants in California, Massachusetts and the UK were 35.9 (1.3), 36.3 (1.3), and 36.3 (1.9) weeks, respectively (p=0.001). Compared to the UK, adjusted discharge of infants occurred 3.9 (95% CI 1.4, 6.5) days earlier in California, and 0.9 (95% CI -1.2, 3.0) days earlier in Massachusetts.Conclusions: Infants of 30 to 34 6/7 weeks gestation at birth admitted and cared for in the hospitals in California have a shorter length of stay compared to those in Massachusetts and the UK. We speculate that certain characteristics of the integrated healthcare approach pursued by the health maintenance organization of the NICUs in California may foster earlier discharge. The California system may provide opportunities for identifying practices for reducing the length of stay of moderately premature infants in Massachusetts and the UK.