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Re: Choice of booking: postnatal implications for infants requiring neonatal community care.

We note with interest the findings of Meerlo-Habing et al that early discharge with nasogastric tube feeding and specialised neonatal community support was associated with longer duration of breastfeeding in preterm infants1. In their study infants were assigned to early discharge with nasogastric tube (NGT) feeding or discharge on full oral feeds based largely on parental wish. In our unit provision of early discharge on NGT feeding is often based on postcode as babies who fall outside of catchment area are ineligible for NGT feeding at home.

We looked prospectively at infants suitable for discharge under the neonatal community team in 2007. 205 infants were discharged home under care of the community team. 250 additional infants were identified as potential candidates for community care but were outside the catchment area. 141 out of area babies were transferred to other hospitals, 14 to the paediatric ward, 11 were discharged home under another community team and 84 went home without community care. In area vs out of area babies were median 35 vs 36 weeks gestation and 2225g vs 2429g at birth, Despite older gestational age stay time on the postnatal ward was increased in out of area infants compared to in area infants (median 7 vs 4 days stay, p<0.001). 57% of in area babies went home breastfeeding compared to 40% of out of area babies.

Are parents truly making an informed choice or are aspects of postnatal care ignored in antenatal decision making? Deficits in community care provision lead to longer postnatal stays costly to both health services and families. Mothers are more likely to forego breastfeeding in an attempt for earlier discharge where NGT feeding is not an option. Choice of booking needs to take these factors into consideration for truly informed choice.