Earlier discharge of very low birthweight infants from an under-resourced African hospital: a randomised trial

Background: Very low birthweight (VLBW) infants contribute substantially to the workload and expenditure of any neonatal unit. Earlier discharge might offer advantages to the infant, the family and the health service. Aim: To establish the outcome of preterm, VLBW infants discharged at a weight of >= 1650 g compared with the unit's practise of discharging at a weight of >= 1800 g. Methods: A total of 120 infants (62 early discharges, 58 routine discharges) were followed up for 3 months after discharge from Chris Hani Baragwanath Hospital in Soweto, South Africa. The early-discharge group was discharged at >= 1650 g and the routine-discharge group at >= 1800 g. Growth, morbidity and mortality at I and 3 months after discharge were compared. Results: At 3 months, the rate of weight gain (mean 30 vs 33 g/kg/day, p=0.06) and head circumference growth (38.9 vs 39.5 cm, p=0.10) were similar in both groups. There were no differences between the early- and routine-discharge groups in the number of outpatient visits (24 vs 16, p=0.18), frequency of re-admission (9 vs 4,p=0.17) or mortality [1 (1.6%) vs 3 (5.2%), p=0.27] following discharge. Conclusion: If home circumstances are adequate, it is as safe to discharge well, singleton VLBW infants from hospital at a weight of >= 1650 g as at >= 1800 g.