Higher neonatal morbidity after routine early hospital discharge: Are we sending newborns home too early?

Background: A growing body of evidence suggests that the trend toward earli er discharge may affect newborn morbidity. The authors assessed how hospita l re admission rates were affected by a clinical guideline aimed at dischar ging newborns from hospital 24 hours after birth. Method: A retrospective before-after cohort study was conducted involving 7 009 infants born by uncomplicated vaginal delivery at a large level II hosp ital in Toronto between Dec. 31, 1993, and Sept. 29, 1997. The primary outc ome was a comparison of the rate of hospital readmission among newborns bef ore (5936 infants) and after (1073 infants) the early-discharge policy was implemented (Apr. 1, 1997). The causes for readmission were secondary outco mes. Results: Before the early-discharge guideline was implemented, the mean len gth of stay declined from 2.25 days (95% confidence interval [CI] 2.18-2.32 ) to 1.88 days (95% CI 1.84-1.92) (p < 0.001). After implementation there w as a further decline, to 1.62 days (95% CI 1.56-1.67) (p < 0.001). A total of 126 infants (11.7%) in the early-discharge cohort required readmission b y 1 month, as compared with 396 infants (6.7%) in the preguideline cohort ( odds ratio 1.86, 95% CI 1.51-2.30). The main reason for early readmission w as neonatal jaundice, with a higher rate among infants in the early-dischar ge cohort than among those in the preguideline cohort (8.6% v. 3.1%; odds r atio 2.96, 95% CI 2.29-3.84). Interpretation: Decreases in newborn length of stay may result in substanti al increases in morbidity. Careful consideration is needed to establish whe ther a reduction in length of stay to less than 24 to 36 hours is harmful t o babies.