Newborn discharge timing and readmissions: California, 1992-1995
Newborn discharge timing and readmissions: California, 1992-1995
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DOI：
10.1542/peds.106.1.31
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发表时间：
2000-07-01
期刊：
影响因子：
8
通讯作者：
Gould, JB
中科院分区：
文献类型：
--
作者：
Danielsen, B;Castles, AG;Gould, JB
上下文新生儿及其母亲在无并发症阴道分娩后住院的时间从1970年的平均4天减少到1995年的1.1天。尽管缺乏对这一趋势的护理质量影响的基于人口的研究，但1996年通过的联邦立法规定了无并发症阴道分娩后48小时住院的保险范围。在加州健康新生儿人群中，评估极早出院（定义为出生当天出院）对新生儿期婴儿再入院风险的影响。回顾性队列研究，基于1992年至1995年所有健康、阴道分娩和常规出院的加州新生儿的出生证明、新生儿和产妇住院记录以及婴儿再入院记录的相关数据集。极早出院和出生后28天内的婴儿再入院。极早或提早出院（在住院一晚后）的婴儿百分比从1992年的71%增加到1995年的85%。极早出院的婴儿百分比从1992年的5.0%上升到1993年的5.7%和1994年的7.0%，然后下降到1995年的6.7%。发现先前与次优妊娠结局相关的特征可降低极早出院的可能性，例如，母体并发症、产次、西班牙裔、非裔美国人、东南亚人、或其他亚洲种族/新生儿期的再入院率最初从1992年的每1 000人27.6名婴儿下降到1994年的每1 000人25.67名婴儿，然后在1995年增加到每1 000人30.2名婴儿。对于提前出院的婴儿，与住院2+晚后出院的婴儿相比，未观察到再入院风险的统计学显著增加。与提前出院的婴儿相比，提前出院的婴儿再入院的调整后优势比（OR）在统计学上显着更高（OR：1.27），第一胎（OR：1.21），患有并发症的母亲所生的婴儿（OR：1.11），有医疗补助保险的婴儿（OR：1.23），以及母亲接受充分产前护理的婴儿（OR：1.15）。女婴的风险在统计学上显著较低（或：在4年的研究中，因脱水和低风险感染而再次住院的婴儿比例在统计学上显著高于早期出院的婴儿（分别为4.37份/千人和10.30份/千人），与提前出院的婴儿相比（分别为千分之3.59和千分之8.16）或住宿2晚以上（分别为千分之2.91和千分之7.95）。因脱水再住院的婴儿比例从1992年的2.89%.增加到1995年的4.52%.。对于出生在加州的健康、经阴道分娩的婴儿，在医院外接受适当的产前和产后护理一晚不会增加再入院的风险。然而，婴儿在出生当天出院的决定应保守应用，因为与过早出院相关的婴儿再入院风险增加。
Context. Hospital stays for newborns and their mothers after uncomplicated vaginal delivery have decreased from an average of 4 days in 1970 to 1.1 days in 1995. Despite the lack of population-based research on the quality-of-care implications of this trend, federal legislation passed in 1996 mandated coverage for 48-hour hospital stays after uncomplicated vaginal delivery.Objective. To assess the impact of very early discharge (defined as discharge on the day of birth) on the risk of infant readmission during the neonatal period in a California healthy newborn population.Design. Retrospective cohort study, based on a linked dataset consisting of the birth certificate, newborn, and maternal hospitalization record, and linked infant readmission records for all healthy, vaginally delivered, and routinely discharged California newborns from 1992 to 1995.Outcome Measures. Very early discharge and infant readmission during the first 28 days of life.Results. The percentage of infants discharged very early or early (after a 1-night stay) increased from 71% in 1992 to 85% in 1995. The percentage of infants discharged very early increased from 5.0% in 1992 to 5.7% in 1993 and 7.0% in 1994, then decreased to 6.7% in 1995. Characteristics that have been previously associated with suboptimal pregnancy outcomes were found to decrease the likelihood of very early discharge, eg, maternal complications, primiparity, and Hispanic, African American, South East Asian, or other Asian race/ethnicity.The rate of readmission in the neonatal period initially decreased from 27.6 infants per 1000 in 1992 to 25.67 infants per 1000 in 1994, then increased to 30.2 infants per 1000 in 1995. For infants discharged early, no statistically significant increase in the risk of readmission was observed, compared with infants discharged after a 2+-night stay. The adjusted odds ratio (OR) for readmission was statistically significantly higher for infants who were discharged very early, compared with infants discharged early (OR: 1.27), first order births (OR: 1.21), infants born to mothers who experienced complications (OR: 1.11), infants with Medicaid insurance (OR: 1.23), and infants born to mothers who received adequate plus prenatal care (OR: 1.15). The risk was statistically significantly lower for female infants (OR: 0.75).The proportion of infants rehospitalized for dehydration and low-risk infections over the 4 study years combined was statistically significantly higher in infants discharged very early (4.37 parts per thousand and 10.30 parts per thousand, respectively), compared with infants discharged early (3.59 parts per thousand and 8.16 parts per thousand, respectively) or after a 2+-night stay (2.91 parts per thousand and 7.95 parts per thousand, respectively). The proportion of infants rehospitalized for dehydration increased statistically significantly from 2.89 parts per thousand in 1992 to 4.52 parts per thousand in 1995.Conclusions. One-night stays with adequate antenatal and postnatal care outside the hospital do not increase the risk of readmission for healthy, vaginally delivered infants born in California. However, the decision to discharge infants on the day of birth should be applied conservatively because of the increased risk of infant readmission associated with very early discharge.