Higher neonatal morbidity after routine early hospital discharge: are we sending newborns home too early?
BACKGROUND
A growing body of evidence suggests that the trend toward earlier discharge may affect newborn morbidity. The authors assessed how hospital readmission rates were affected by a clinical guideline aimed at discharging newborns from hospital 24 hours after birth.


METHODS
A retrospective before-after cohort study was conducted involving 7009 infants born by uncomplicated vaginal delivery at a large level II hospital in Toronto between Dec. 31, 1993, and Sept. 29, 1997. The primary outcome was a comparison of the rate of hospital readmission among newborns before (5936 infants) and after (1073 infants) the early-discharge policy was implemented (Apr. 1, 1997). The causes for readmission were secondary outcomes.


RESULTS
Before the early-discharge guideline was implemented, the mean length of stay declined from 2.25 days (95% confidence interval [CI] 2.18-2.32) to 1.88 days (95% CI 1.84-1.92) (p < 0.001). After implementation there was a further decline, to 1.62 days (95% CI 1.56-1.67) (p < 0.001). A total of 126 infants (11.7%) in the early-discharge cohort required readmission by 1 month, as compared with 396 infants (6.7%) in the preguideline cohort (odds ratio 1.86, 95% CI 1.51-2.30). The main reason for early readmission was neonatal jaundice, with a higher rate among infants in the early-discharge cohort than among those in the preguideline cohort (8.6% v. 3.1%; odds ratio 2.96, 95% CI 2.29-3.84).


CONCLUSIONS
Decreases in newborn length of stay may result in substantial increases in morbidity. Careful consideration is needed to establish whether a reduction in length of stay to less than 24 to 36 hours is harmful to babies.
Lock
M
M
Scarborough General Hospital, University of Toronto.
Ray
J G
JG
D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009017:Morbidity / Q000639:trends*; D010351:Patient Discharge / Q000592:standards*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment