AIM To identify risk factors for delayed discharge home in a population-based cohort of very-low-birthweight (VLBW) infants. METHODS Demographic, pregnancy, perinatal, and neonatal data were collected in a national population-based database on VLBW infants born from 1995 through 2002. Multivariate analysis determined association with delayed discharge (discharge at a postmenstrual age >42 completed weeks). RESULTS 882 infants with delayed discharge comprised 9.4% of survivors but accounted for 19.8% of total hospital days utilized until discharge home. Infants with delayed discharge compared to those discharged by term were born at an earlier mean gestational age, at a lower mean birthweight, and had a longer mean hospital stay. Delayed discharge was independently associated with decreasing birthweight (OR 1.25, 95% CI 1.19, 1.31), congenital anomalies (OR 4.80, 95% CI 3.66, 6.28), bronchopulmonary dysplasia (OR 5.88, 95% CI 4.60, 7.57), intraventricular hemorrhage grades 3-4 (OR 1.78, 95% CI 1.34, 2.36), sepsis (OR 1.87, 95% CI 1.54, 2.26), and surgically treated necrotizing enterocolitis (OR 20.20, 95% CI 12.85, 32.03). CONCLUSION VLBW infants with congenital anomalies or severe complications of preterm birth are at increased risk for delayed discharge home. Early identification of these infants may enable interventions aimed at reducing the detrimental effects of prolonged hospitalization and promoting optimal transition from the hospital to the home environment.