The safety of newborn early discharge: The Washington State experience

Context. - While early discharge of newborns following routine vaginal delivery has become common practice, its safety has not been firmly established. Objective. - To assess the risk for rehospitalization following newborn early discharge. Design. - Population-based, case-control study. Setting. - Washington State linked birth certificate and hospital discharge abstract covering 310 578 live births from 1991 through 1994. Patients. - Case patients were 2029 newborns rehospitalized in the first month of life. Control subjects were 8657 randomly selected newborns not rehospitalized and frequency matched to case patients on year of birth. Cesarean deliveries, multiple births, and births at less than 36 weeks' gestation were not included. Main Outcome Measure. - Stratified analyses and logistic regression were performed to assess the risk for rehospitalization within a month of birth after early discharge (<30 hours after birth) compared with later discharge (30-78 hours after birth). Results. - Seventeen percent of newborns were discharged early. Newborns discharged early were more likely to be rehospitalized within 7 days (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.11-1.47), 14 days (OR, 1.16; 95% CI, 1.03-1.32), and 28 days (OR, 1.12; 95% CI, 1.00-1.25) of discharge than newborns sent home later. Subgroups at increased risk for rehospitalization following early discharge included newborns born to primigravidas (OR, 1.25; 95% CI, 1.07-1.45), mothers younger than 18 years (OR, 1.22; 95% CI, 0.79-1,91), and mothers with premature rupture of membranes (OR, 1.41; 95% CI, 0.85-2.36). Early discharge was also associated with an increased risk of readmission for jaundice, dehydration, and sepsis. Conclusion. - Newborns discharged home early (<30 hours after birth) are at increased risk for rehospitalization during the first month of life.