Hidden Risks: Early Discharge and Bilirubin Toxicity Due to Glucose 6-Phosphate Dehydrogenase Deficiency

Abstract

In the United States today it is common for a mother motherand her term newborn to leave the hospital at 12 to 48 hours postnatally. Current opinion varies widely regarding the desirability of this practice. Proponents of early discharge claim that it is safe and may be advantageous; opponents argue that detection of significant illness may be missed or delayed. Economic considerations often limit the choice of families and their physicians; as they fund progressively shorter hospital stays, managed care and health insurance companies constitute a major driving force toward earlier postpartum discharge.

The American Academy of Pediatrics (AAP)^1,2 and the American College of Obstetricians and Gynecologists (ACOG) have published criteria to be met by early discharge candidates.² These basic criteria include attendance at prenatal classes, instruction regarding common neonatal problems, uncomplicated term delivery, normal physical examination, thermal homeostasis, a negative Coombs test, demonstration of basic maternal skills, including successful infant feeding, and "physician-directed" follow-up within 48 to 72 hours after discharge.

NEONATAL MORBIDITY AND MORTALITY: RELATIONSHIP TO TIME OF DISCHARGE

Many neonatal problems do not become apparent for several days. However, the risks of early discharge remain poorly defined. Among published series of infants discharged early, mortality rates are low and not significantly different from those of control infants.^3-6 Most studies have compared morbidity (rates of hospital readmission) between infants discharged early and late and have found similar rates of readmission between groups.^7-9 There are few prospective, randomized studies; those that have been published have significant methodological flaws.^3,10-16 For example, length of hospital stay varies, and length of stay and timing of follow-up overlap with control infants; study sample sizes are small, usually less than 100 per study.