PEDIATRICS Vol. 106 No. 1 July 2000, pp. 31-39
Newborn Discharge Timing and Readmissions: California, 1992-1995
Received Feb 19, 1999; accepted Aug 6, 1999.
,, and
From * Health Information Solutions, Pacific Business Group
on Health, and § University of California, Berkeley, School of Public
Health, Berkeley, California.
Context. Hospital stays for newborns and their mothers after uncomplicated vaginal delivery have decreased from an average of 4 days in 1970 to 1.1 days in 1995. Despite the lack of population-based research on the quality-of-care implications of this trend, federal legislation passed in 1996 mandated coverage for 48-hour hospital stays after uncomplicated vaginal delivery.
Objective. To assess the impact of very early discharge (defined as discharge on the day of birth) on the risk of infant readmission during the neonatal period in a California healthy newborn population.
Design. Retrospective cohort study, based on a linked dataset consisting of the birth certificate, newborn, and maternal hospitalization record, and linked infant readmission records for all healthy, vaginally delivered, and routinely discharged California newborns from 1992 to 1995.
Outcome Measures. Very early discharge and infant readmission during the first 28 days of life.
Results. The percentage of infants discharged very
early or early (after a 1-night stay) increased from 71% in 1992 to
85% in 1995. The percentage of infants discharged very early increased
from 5.0% in 1992 to 5.7% in 1993 and 7.0% in 1994, then decreased to 6.7% in 1995. Characteristics that have been previously associated with suboptimal pregnancy outcomes were found to decrease the likelihood of very early discharge, eg, maternal complications, primiparity, and Hispanic, African American, South East Asian, or other
Asian race/ethnicity.The rate of readmission in the neonatal period initially decreased from
27.6 infants per 1000 in 1992 to 25.67 infants per 1000 in 1994, then
increased to 30.2 infants per 1000 in 1995. For infants discharged
early, no statistically significant increase in the risk of readmission
was observed, compared with infants discharged after a 2+-night stay.
The adjusted odds ratio (OR) for readmission was statistically
significantly higher for infants who were discharged very early,
compared with infants discharged early (OR: 1.27), first order births
(OR: 1.21), infants born to mothers who experienced complications (OR:
1.11), infants with Medicaid insurance (OR: 1.23), and infants born to
mothers who received adequate plus prenatal care (OR: 1.15). The risk
was statistically significantly lower for female infants (OR: 0.75). The proportion of infants rehospitalized for dehydration and low-risk
infections over the 4 study years combined was statistically significantly higher in infants discharged very early (4.37
and 10.30, respectively), compared with infants discharged early (3.59 and 8.16, respectively) or after a 2+-night stay (2.91 and 7.95, respectively). The proportion of infants rehospitalized for dehydration increased statistically significantly from 2.89 in
1992 to 4.52 in 1995.
Conclusions. One-night stays with adequate antenatal and postnatal care outside the hospital do not increase the risk of readmission for healthy, vaginally delivered infants born in California. However, the decision to discharge infants on the day of birth should be applied conservatively because of the increased risk of infant readmission associated with very early discharge. Key words: neonatal length of stay, early discharge, readmission.
This article has been cited by other articles:
 |
|
 |
|
  A. E. Burgos, S. K. Schmitt, D. K. Stevenson, and C. S. Phibbs Readmission for Neonatal Jaundice in California, 1991-2000: Trends and Implications Pediatrics, April 1, 2008; 121(4): e864 - e869. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. H. Bernstein, C. Spino, S. Finch, R. Wasserman, E. Slora, C. Lalama, C. L. Touloukian, H. Lilienfeld, and M. C. McCormick Decision-Making for Postpartum Discharge of 4300 Mothers and Their Healthy Infants: The Life Around Newborn Discharge Study Pediatrics, August 1, 2007; 120(2): e391 - e400. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L Hepburn, M Miller, D Azrael, and D Hemenway The US gun stock: results from the 2004 national firearms survey Inj. Prev., February 1, 2007; 13(1): 15 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. M. Paul, E. B. Lehman, C. S. Hollenbeak, and M. J. Maisels Preventable Newborn Readmissions Since Passage of the Newborns' and Mothers' Health Protection Act Pediatrics, December 1, 2006; 118(6): 2349 - 2358. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. A. Galbraith, D. C. Grossman, T. D. Koepsell, P. J. Heagerty, and D. A. Christakis Medicaid Acceptance and Availability of Timely Follow-up for Newborns With Medicaid Pediatrics, November 1, 2005; 116(5): 1148 - 1154. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S J Oddie, D Hammal, S Richmond, and L Parker Early discharge and readmission to hospital in the first month of life in the Northern Region of the UK during 1998: a case cohort study Arch. Dis. Child., February 1, 2005; 90(2): 119 - 124. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. M. Paul, T. A. Phillips, M. D. Widome, and C. S. Hollenbeak Cost-Effectiveness of Postnatal Home Nursing Visits for Prevention of Hospital Care for Jaundice and Dehydration Pediatrics, October 1, 2004; 114(4): 1015 - 1022. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Martens, S. Derksen, and S. Gupta Predictors of Hospital Readmission of Manitoba Newborns Within Six Weeks Postbirth Discharge: A Population-Based Study Pediatrics, September 1, 2004; 114(3): 708 - 713. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Committee on Fetus and Newborn Hospital Stay for Healthy Term Newborns Pediatrics, May 1, 2004; 113(5): 1434 - 1436. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Lichtenstein, C. Brumfield, S. Cliver, V. Chapman, D. Lenze, and V. Davis Giving Birth, Going Home: Influences on when Low-Income Women Leave Hospital Health (London) , January 1, 2004; 8(1): 81 - 100. [Abstract] [PDF]
|
|
|
|
|
|
J. D. Malkin, E. Keeler, M. S. Broder, and S. Garber Postpartum Length of Stay and Newborn Health: A Cost-Effectiveness Analysis Pediatrics, April 1, 2003; 111(4): e316 - 322. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. A. Galbraith, S. A. Egerter, K. S. Marchi, G. Chavez, and P. A. Braveman Newborn Early Discharge Revisited: Are California Newborns Receiving Recommended Postnatal Services? Pediatrics, February 1, 2003; 111(2): 364 - 371. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Hyman What Lessons Should We Learn From Drive-Through Deliveries? Pediatrics, February 1, 2001; 107(2): 406 - 407. [Full Text]
|
|
