NEONATAL-MORTALITY AND LENGTH OF NEWBORN HOSPITAL STAY

Objective. To investigate the effect of hospital discharge time on neo natal mortality of term newborns. Design. Infants who were discharged home at 5 days of age or younger and who subsequently died were compar ed with control infants using a retrospective case-control design. Des criptive information was collected from records of infants who were no t discharged home from the hospital of birth (because of death or tran sfer to a tertiary care hospital) to determine the age at which their illnesses presented. Methods. We reviewed death certificates for all i nfants with birth weights of 2500 g or greater born at 37 weeks' gesta tional age or greater who died in the first 28 days of life and who we re born in one of four Utah counties (1985 through 1989). Of the 109 2 56 eligible births, 115 infants were found who had died in the neonata l period. Eighty-four infants had not been discharged home from the ho spital of birth, 5 infants had had hospital stays of more than 5 days, 9 records could not be located, 17 presumed healthy infants were disc harged from the hospital at 5 days of age or younger. These 17 infants were each matched with 3 control infants. Newborn nursery charts were reviewed to determine hospital discharge times for case and control i nfants. Descriptive information regarding the time of presentation of illness was collected for the other 89 infants. Results. The mean age of hospital discharge was 43 +/- 21 hours for the 17 case infants and 47 +/- 25 hours for the 51 control infants. The odds ratio for neonata l mortality for discharge at less than 24 hours was 1.65 (95% confiden ce interval, 0.42 to 3.34) and for discharge at less than 48 hours was 1.16 (95% confidence interval, 0.4 to 3.34). Of the 84 infants who we re not discharged home from the hospital of birth, 93% had been sympto matic by 12 hours of age, and 99% were symptomatic by 18 hours. Conclu sions. Most full-term infants who die in the neonatal period are sympt omatic within the first 18 hours after birth. We could not demonstrate an association between early hospital discharge and neonatal mortalit y in those infants who died after discharge home.