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Higher neonatal morbidity after routine early hospital discharge

Are we sending newborns home too early?

Dr. Lock is with the Scarborough General Hospital, University of Toronto, and the Department of Cardiology, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ont.; Dr. Ray is with the Obstetrical Medicine Programme, Sunnybrook & Women's College Health Sciences Centre, University of Toronto, and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.
Presented at the College of Family Physicians of Canada annual national scientific assembly, Halifax, May 8, 1998.

Abstract

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.

Method: 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 [Cl] 2.18-2.32) to 1.88 days (95% Cl 1.84-1.92) (p < 0.001). After implementation there was a further decline, to 1.62 days (95% Cl 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% Cl 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% Cl 2.29-3.84).

Interpretation: 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.

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