title: Newborn early discharge revisited: are California newborns receiving recommended postnatal services?
abstract: BACKGROUND
  Responding to safety concerns, federal and state legislation mandated coverage of minimum postnatal stays and state legislation in California mandated coverage of follow-up after early discharge. Little is known about the postnatal services newborns are receiving.
  
  
  OBJECTIVE
  To describe rates of early discharge and of timely follow-up for early-discharged newborns.
  
  
  METHODS
  Retrospective, population-based cohort study using a 1999 postpartum survey in California.
  
  
  METHODS
  A total of 2828 infants of mothers with medically low-risk singleton births.
  
  
  METHODS
  Rates of early discharge (<or=1-night stay after vaginal delivery and <or=3-night stay after cesarean section) and untimely follow-up (no home or office visit within 2 days of early discharge).
  
  
  RESULTS
  Overall, 49.4% of newborns were discharged early. Of these, 67.5% had untimely follow-up. The odds of early discharge were greater with lower incomes: the adjusted odds ratios (AORs) (with 95% confidence intervals) were 2.06 (1.50-2.83) for incomes <or=100% of poverty, 2.20 (1.65-2.93) for incomes from 101%-200% of poverty, and 2.24 (1.63-3.08) for incomes from 201%-300% of poverty. Untimely follow-up was more likely for infants of women with incomes <or=100% of poverty (AOR = 1.89 [1.13-3.17]) and 201%-300% of poverty (AOR = 1.78 [1.09-2.91]), Medicaid coverage (AOR = 1.73 [1.20-2.47]), Latina ethnicity (AOR = 1.47 [1.02-2.14]), and non-English language (AOR = 1.72 [1.16-2.55]).
  
  
  CONCLUSIONS
  Despite an apparent decline in short stays after legislation, many newborns--particularly from lower-income families--continue to be discharged early. Most newborns discharged early--particularly those with Medicaid and those from low-income, Latina, and non-English-speaking homes--do not receive recommended follow-up. The most socioeconomically vulnerable newborns are receiving fewer postnatal services.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, University of Washington, Seattle, Washington 98195-7183, USA. agalb@u.washington.edu
authors.forename: Alison A
authors.initials: AA
authors.lastname: Galbraith
authors.forename: Susan A
authors.initials: SA
authors.lastname: Egerter
authors.forename: Kristen S
authors.initials: KS
authors.lastname: Marchi
authors.forename: Gilberto
authors.initials: G
authors.lastname: Chavez
authors.forename: Paula A
authors.initials: PA
authors.lastname: Braveman
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California; D002585:Cesarean Section / Q000706:statistics & numerical data / Q000639:trends; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006287:Health Planning Guidelines; D006792:House Calls / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D010351:Patient Discharge / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends*; D011159:Population Surveillance / Q000379:methods*; D011181:Postnatal Care / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D012959:Socioeconomic Factors