Elsevier

Obstetrics & Gynecology

Volume 96, Issue 2, August 2000, Pages 183-188
Obstetrics & Gynecology

Original articles
Infant mortality and early postpartum discharge

https://doi.org/10.1016/S0029-7844(00)00894-2Get rights and content

Abstract

Objective: To assess additional risk of newborn death owing to early discharge.

Methods: This was a historical cohort study using Washington State linked birth certificates, death certificates, and hospital discharge records that covered 47,879 live births in 1989 and 1990. Logistic regression was used to assess risk of death within the first year of life after early discharge (less than 30 hours after birth) compared with later discharge (30–78 hours after birth).

Results: Newborns discharged early were more likely to die within 28 days of birth (odds ratio [OR] 3.65; 95% confidence interval [CI] 1.56, 8.54), between 29 days and 1 year (OR 1.61; 95% CI 1.10, 2.36), and any time within the first year (OR 1.84; 95% CI, 1.31, 2.60) of life than newborns sent home later. Newborns discharged early also were more likely to die of heart-related problems (OR 3.72; CI 1.25, 11.04) and infections (OR 4.72; CI 1.13, 19.67) within 1 year of birth than newborns discharged later.

Conclusion: Newborns discharged within 30 hours of birth are at increased risk of death within the first year of life.

Section snippets

Materials and methods

We conducted a historical cohort study using data from the 1989 to 1990 Washington State Birth Event Record Database, which links birth certificate and infant death certificate records with maternal and newborn hospital discharge records. The file includes time and date of birth, date (but not time) of discharge, and sociodemographic and clinical characteristics. Approval was obtained from the RAND Human Subjects Protection Committee.

Of approximately 150,000 total births in Washington in 1989

Results

Comparisons of average maternal characteristics for the groups, such as marital status, Medicaid status, and age, indicated that newborns discharged early had significantly lower socioeconomic status than newborns with longer stays (Table 1). Other measures indicated that newborns discharged early were significantly healthier on average and that their mothers were significantly more likely to be multiparous—perhaps because second and subsequent vaginal deliveries were often easier than first.

Discussion

Based on our reading of two literature reviews3, 17 and 37 abstracts identified through the MEDLINE database (1996–1999) using the search terms “infant,” “newborn,” “postpartum,” “maternal,” “perinatal,” “birth,” “length of stay,” “early discharge,” “death,” and “mortality,” this is the first study to establish a statistically significant association between early postpartum discharge and newborn mortality. One retrospective case-control study16 and one randomized controlled trial18 found that

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This study was supported by grant R03 HS09342-01 from the Agency for Health Care Policy and Research (AHCPR). It is based on data collected under the Management and Outcomes of Childbirth Patient Outcomes Research Team (PORT), which was supported by a contract to RAND (282-90-0039) from AHCPR.

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