A CRITICAL-REVIEW OF STUDIES OF NEWBORN DISCHARGE TIMING

The duration of hospitalization for newborns has declined dramatically , driven by efforts to control health-care costs as well as by efforts to demedicalize childbirth. In order to determine the clinical basis for this practice, the quality of the published literature on discharg e timing was analyzed. Thirteen experimental or quasi-experimental stu dies were retrieved through a computer search. Seven characteristics t hat influenced the quality of these studies were reviewed: research de sign; measures of effect; sample descriptions; statistical methods; re liability measures; sample size; and the definition of early discharge , including the use of any related interventions. Although all 13 stud ies suggest that there are no differences between infants discharged e arly and their compeers, these studies have three limitations. First, with one exception, these reports are from hospitals where well-define d assessment and follow-up protocols have been established, potentiall y limiting their wide applicability, Second, these studies lack statis tical power to assess the likelihood of rare events such as readmissio n. Third, few studies report outcomes other than readmission and medic al conditions diagnosed within 1 to 6 weeks. Early discharge as the st andard of care for well newborns has not been well established by empi rical studies, Pediatricians and local public health officials have a responsibility to assure that the health objectives of hospitalization are met whether this occurs in the hospital or through other mechanis ms, such as routine home visiting.