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Criteria for discharge of preterm infants from Canadian neonatal intensive care units

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Abstract

Initial discharge from a neonatal intensive care unit (NICU) to home is a crucial milestone that impacts preterm infants, their families, and NICUs. Standardized discharge programs individualized for family needs can ensure a safe transfer of care to parents, decrease the length of stay and hospital costs, and improve parents’ satisfaction. To assess the degree of variability in the current discharge criteria of preterm infants less than 34 weeks' gestation among Canadian NICUs, explore different institution-specific guidelines and degree of adherence to the Canadian Paediatric Society (CPS) guidelines. A clinical representative of each of the 117 level 2–4 Canadian NICUs was contacted via email to participate in an anonymous survey link regarding the discharge criteria of preterm infants. Responders from ninety-eight NICUs (84%), representing all Canadian provinces, completed the survey. Most were nurse practitioners (43%) and neonatologists (31%) with > 5 years of experience (87%). Level 3 and 4 NICUs represented 63% of responses. Units varied widely in many discharge criteria and in their adherence to CPS guidelines. Most of the units (81%) lack written discharge guidelines; 60% do not have a dedicated discharge coordinator, and 45% do not have a post-discharge clinic. Only 25% routinely teach parents CPR and only half of the surveyed units provide parental support programs.

  Conclusion: There is a significant heterogeneity in discharge practices of preterm infants among Canadian NICUs. This survey provides a basis for benchmarking and knowledge sharing.

What is Known:

• Discharging preterm infants from the NICU impacts preterm infants, their families, and NICUs.

• All efforts should ensure a safe transfer of care to parents, decrease the length of stay, better utilize resources, and improve parents’ satisfaction.

What is New:

• The discharge criteria of preterm infants vary widely among NICUs.

• This survey provides benchmark information and exposes the need to better standardize discharge practices and the subsequent support for infants and parents.

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Abbreviations

NICU:

Neonatal intensive care unit

NNPs:

Neonatal nurse practitioners

CNSs:

Clinical nurse specialists

CPS:

Canadian Pediatric Society

CGA:

Corrected gestational age

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Acknowledgements

We would like to thank all the units that participated in the survey as well as Dr. Douglas McMillan for reviewing the manuscript.

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Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, IWK Health Centre and Dalhousie University, 5850/5980 University Ave, PO Box 9700, Halifax, NS, B3K 6R8, Canada

    Helen McCord, Elise Fieldhouse & Walid El-Naggar

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  1. Helen McCord
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  2. Elise Fieldhouse
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  3. Walid El-Naggar
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Contributions

HM was involved in the survey design, setting up the electronic version, collecting the data, and manuscript preparation. EF was involved in the survey design, obtaining REB approval, reviewing the data, and manuscript preparation. WE was involved in the survey design, reviewing the data, and manuscript preparation.

Corresponding author

Correspondence to Walid El-Naggar.

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Ethics approval

The study was approved by the local Research Ethics Board of the IWK Health Centre (Project # 1027205).

Competing interests

The authors have no competing interests relevant to this article to disclose.

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Communicated by Daniele De Luca

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McCord, H., Fieldhouse, E. & El-Naggar, W. Criteria for discharge of preterm infants from Canadian neonatal intensive care units. Eur J Pediatr 183, 1759–1763 (2024). https://doi.org/10.1007/s00431-024-05424-7

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