@article {Lock249, author = {Michael Lock and Joel G. Ray}, title = {Higher neonatal morbidity after routine early hospital discharge}, volume = {161}, number = {3}, pages = {249--253}, year = {1999}, publisher = {CMAJ}, 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.}, issn = {0820-3946}, URL = {https://www.cmaj.ca/content/161/3/249}, eprint = {https://www.cmaj.ca/content/161/3/249.full.pdf}, journal = {CMAJ} }