THE EFFECT OF EARLY DISCHARGE AND OTHER FACTORS ON READMISSION RATES OF NEWBORNS

Objective: To assess the relationship between early discharge, breast- feeding, and other factors on hospital readmission of newborns. Design : Retrospective record review. Setting: An urban, private community ho spital. Patients: All newborns born over a 1-year period who were read mitted to the hospital within the first 3 weeks of life (n=117). The c ontrol group consisted of a systematic sampling of newborns born over die same period who were not readmitted (n=147). Results: Early discha rge, defined as discharge when younger than 24, 36, or 48 hours of age , does not seem to contribute to readmission. However, newborns whose initial stay was longer than 72 hours were at significantly lower risk for readmission (P=.02, chi(2)). Factors in the initial hospitalizati on associated with readmission included vaginal delivery and length of stay less than 72 hours (difference, 12 percentage points; 95% confid ence interval [CI], 4% to 20%; P=.005), need for performance of a comp lete blood count (CBC) (difference, 16 percentage points; CI 6% to 26% ; P=.002), presence of jaundice (difference, 17 percentage points; CI, 5% to 29%; P=.005), and gestational age 37 weeks or less (difference, 10 percentage points; CI, 2% to 18%; P=.02), discharge weight less th an 3 kg (difference, 11 percentage points; CI, 0 to 22%; P=.05). Howev er, almost all newborns delivered vaginally were discharged within les s than 72 hours, so our ability to comment on the independent effect o f delivery mode on readmission is limited. A trend toward significance was noted between breast-feeding and readmission (difference, 9 perce ntage points; CI, 0% to 18%; P=.07). However, when only vaginal delive ries were considered, this association was statistically significant ( difference, 13 percentage points; CI, 4% to 22%; P=.02). A significant association was noted between breast-feeding and jaundice or dehydrat ion. Of babies admitted with jaundice or dehydration, 94% were breast- fed, compared with 67% of babies admitted with neither jaundice nor de hydration (difference, 27 percentage points; CI, 13% to 41%; P<.001). Conclusions: These findings strongly suggest that early discharge (at younger than 24, 36, or 48 hours of age) from the hospital is not asso ciated with hospital readmission within the first 3 weeks of life. Fac tors associated with readmission included breast-feeding, vaginal deli very and length of stay less than 72 hours, jaundice or need for a CBC , gestational age of 37 weeks or less, and discharge weight less than 3 kg.