Five-year experience with an early discharge program in well newborns.
OBJECTIVE
This study was conducted to determine if early postnatal discharge (< or = 48 hrs; EDC) in well newborns had an effect on the rate of hospital readmission within the first week after hospital discharge when compared to infants who remained > 48 hrs after birth (LDC).


METHODS
This was a retrospective medical chart review. Infants who were born at Norton Hospital in Louisville, Kentucky, between 1/1/94 and 12/31/98, discharged as well newborns and treated at Kosair Children's Hospital, Louisville, Kentucky, within 7 days of neonatal discharge, were eligible for review. Infants were categorized by length of neonatal hospital stay, level of medical intervention (emergency department treatment or hospital admission) and final diagnosis.


RESULTS
There was a significant increase in hospital readmission rates for LDC infants when compared to EDC infants. When considering jaundice alone as an admitting diagnosis, EDC infants were admitted at a rate 4 times that of LDC infants and with higher serum bilirubin concentrations. Jaundiced infants were almost uniformly breast-fed.


CONCLUSIONS
Overall, early discharge of well newborns appears to be a safe and reasonable practice. However, the risk for severe jaundice is an unresolved issue which requires a discharge strategy and early follow-up to prevent serious morbidity. Early discharge should not be implemented without a mechanism for early follow-up within 48 hours of discharge.
Radmacher
P G
PG
Department of Pediatrics, Division of Neonatal Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
Massey
C M
CM
Adamkin
D H
DH
D006801:Humans; D007231:Infant, Newborn; D007565:Jaundice; D007629:Kentucky / Q000453:epidemiology; D007902:Length of Stay; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011181:Postnatal Care / Q000592:standards*; D012189:Retrospective Studies