Study Finds Association Between Early Postpartum Discharge and Infant Mortality

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Newborns discharged within 30 hours of birth are at increased risk of death within the first year of life, concludes a study in the August issue of Obstetrics & Gynecology. Researchers assessed risk of death within the first year of life after early discharge (less than 30 hours after birth) compared with later discharge (30 to 78 hours). The study used linked birth certificates, death certificates, and hospital discharge records that covered 47,879 births in Washington State in 1989 and 1990. The authors state that to their knowledge "this is the first study to establish a statistically significant association between early postpartum discharge and newborn mortality."

Study results include the following:

• Newborns discharged early were more likely to die within 28 days of birth, between 29 days and 1 year, and any time within the first year of life than newborns sent home later.
• Newborns discharged early were more likely to die of heart-related problems and infections within 1 year of birth than newborns discharged later.
• Comparison of average maternal characteristics for the groups (i.e., marital status, Medicaid status) indicated that newborns discharged early had significantly lower socioeconomic status than newborns with longer stays.
• Newborns discharged early were significantly healthier on average, and their mothers were significantly more likely to be multiparous--perhaps because second and subsequent vaginal deliveries are often easier than first.
• Of the 155 deaths in the sample, 103 (66.5%) were attributed to sudden infant death syndrome (SIDS), 14 (9%) were caused by heart-related conditions, and 8 (5.2%) were caused by infection. Accidents and injuries caused 13 deaths, and other deaths were attributed to nervous system conditions, respiratory conditions, gastrointestinal conditions, and other conditions.
• The authors did not evaluate the cost of requiring longer hospital stays. They did, however, estimate that about 1,400 infants in the early-discharge group would have had to be moved to the late-discharge category to prevent one infant death.

The article notes that the incidence of SIDS in the sample was 0.22%, higher than the 0.14% national rate for infants in 1989. It also notes a study limitation: since time of discharge was not included in the data set, length of stay could not be calculated to the hour.

In assessing the generalizability of their findings, the authors state that Washington has a lower percentage of teen births and racial and ethnic minority births than the national average. However, they state that "if an increase in length of stay has a disproportionately beneficial effect on minorities or teen mothers (for example, teen mothers may have a greater need than older mothers to receive instruction on caring for their newborns), the mortality effects of early discharge . . . might understate those effects nationally." They also state that their research predates the mandating of length-of-stay laws, which is a strength, and that it predates the American Academy of Pediatrics' Back to Sleep campaign, which was designed to prevent SIDS. Referring to the campaign, they state that "in the presence of such a concerted educational effort, we hypothesize that longer postpartum stays would decrease mortality even further than what was seen in our sample."

Malkin JD et al. 2000. Infant mortality and early discharge. Obstetrics & Gynecology 96(2):183-188.

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MCH Alert. 2001. Arlington, VA: National Center for Education in Maternal and Child Health. http://www.ncemch.org/alert.