Abstract
Context: Postnatal length of hospital stay has reduced internationally but evidence based policies to support earlier discharge are lacking.
Objective: To determine effects of early postnatal discharge on infant outcomes.
Data Sources: CENTRAL, Medline, EMBASE, CINAHL, SCi were searched through to January 15, 2018.
Study Selection: Studies reporting infant outcomes with early postnatal discharge versus standard discharge were included if they met Effective Practice and Organisation of Care study design criteria.
Data extraction: Two authors independently assessed eligibility and extracted data, resolving disagreements by consensus. Data from interrupted time series studies (ITSs) were extracted and reanalysed in meta-analyses. Meta-analyses of RCTs used random effects models.
Results: Of 9298 studies identified, 15 studies satisfied the inclusion criteria. RCT meta-analyses showed that infants discharged <48 hours following vaginal birth and <96 hours following caesarean birth were more likely to be readmitted to hospital within 28 days compared to standard discharge (RR 1.70, 95% CI 1.34-2.15). ITSs meta-analyses showed a reduction in the proportion of infants readmitted within 28 days after minimum postnatal stay policies and legislation were introduced (change in slope, -0.62 (95% CI-1.83, 0.60) with increasing impact in the first and second years (effect estimate -4.27 (95% CI -7.91,-0.63) and -6.23 (95% CI -10.15,-2.32).
Limitations: Withdrawals and crossover limited the value of RCTs in this context but not ITS evidence.
Conclusions: Infants discharged early after birth were more likely to be admitted within 28 days. Introduction of postnatal minimum length of stay policies was associated with long term reduction in neonatal hospital readmission rates.
Objective: To determine effects of early postnatal discharge on infant outcomes.
Data Sources: CENTRAL, Medline, EMBASE, CINAHL, SCi were searched through to January 15, 2018.
Study Selection: Studies reporting infant outcomes with early postnatal discharge versus standard discharge were included if they met Effective Practice and Organisation of Care study design criteria.
Data extraction: Two authors independently assessed eligibility and extracted data, resolving disagreements by consensus. Data from interrupted time series studies (ITSs) were extracted and reanalysed in meta-analyses. Meta-analyses of RCTs used random effects models.
Results: Of 9298 studies identified, 15 studies satisfied the inclusion criteria. RCT meta-analyses showed that infants discharged <48 hours following vaginal birth and <96 hours following caesarean birth were more likely to be readmitted to hospital within 28 days compared to standard discharge (RR 1.70, 95% CI 1.34-2.15). ITSs meta-analyses showed a reduction in the proportion of infants readmitted within 28 days after minimum postnatal stay policies and legislation were introduced (change in slope, -0.62 (95% CI-1.83, 0.60) with increasing impact in the first and second years (effect estimate -4.27 (95% CI -7.91,-0.63) and -6.23 (95% CI -10.15,-2.32).
Limitations: Withdrawals and crossover limited the value of RCTs in this context but not ITS evidence.
Conclusions: Infants discharged early after birth were more likely to be admitted within 28 days. Introduction of postnatal minimum length of stay policies was associated with long term reduction in neonatal hospital readmission rates.
| Original language | English |
|---|---|
| Article number | e20193365 |
| Number of pages | 23 |
| Journal | Pediatrics |
| Volume | 146 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 21 Aug 2020 |
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health