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M. Bruce Edmonson, MD, MPH; Jeffrey J. Stoddard, MD; Laura M. Owens

JAMA. 1997;278(4):299-303.

Abstract
Context.
—Increasingly short postpartum hospital stays in the United States precipitated a policy debate that culminated in passage of the Newborns' and Mothers' Health Protection Act of 1996. The debate occurred without population-based evidence for adverse health effects in newborns who are discharged early.

Objective.
—To determine whether early postpartum hospital discharge of normal newborns increases their risk for hospital readmission with feeding-related problems.

Design and Setting.
—Nested case-control analysis of 1991 to 1994 Wisconsin birth certificate and hospital discharge data.

Subjects.
—A total of 210 readmitted case patients and 630 control subjects selected from a cohort of 120 290 normal newborns who weighed at least 2500 g, were delivered vaginally of mothers with uncomplicated medical and obstetrical histories, and were discharged from the hospital either early (day of life 1 or 2) or conventionally (day 3).

Outcome Measure.
—Readmission at age 4 to 28 days with discharge diagnoses indicating a primary feeding problem, secondary dehydration, or inadequate weight gain.

Results.
—Early discharges increased 3-fold (reaching 521/1000 discharges) during the study period, but feeding-related readmissions (1.7/1000) remained stable. Most readmitted newborns (53.8%) were 4 to 7 days old, many (34.3%) had concurrent dehydration and jaundice, and 29% were admitted through emergency departments. Readmitted newborns were significantly (P<.05) more likely to have been breast-fed, firstborn, or preterm or to have mothers who were poorly educated (<12th grade), unmarried, or receiving Medicaid. Readmission was not associated with early discharge (adjusted odds ratio, 1.05; 95% confidence interval, 0.71-1.53).

Conclusion.
—Although several neonatal and maternal factors increase the risk that a normal newborn will be rehospitalized with a feeding-related problem, early discharge following an uncomplicated postpartum hospital stay appears to have little or no independent effect on this risk.

Author Affiliations
From the Departments of Pediatrics (Drs Edmonson and Stoddard) and Preventive Medicine (Dr Stoddard), Center for Health Sciences, University of Wisconsin-Madison, and the Center for Health Statistics, Wisconsin Division of Health. Madison (Ms Owens).

Footnotes
Corresponding author: M. Bruce Edmonson, MD, MPH, Department of Pediatrics, H6/440 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-4116.

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