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Early Postnatal Discharge for Infants: A Meta-analysis
Eleanor Jones1, Beck Taylor2, Christine MacArthur2
1Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; and e.jones.10@bham.ac.uk.
Insights
Early postnatal discharge increases infant readmission risk. However, implementing minimum hospital stay policies significantly reduces neonatal readmissions over time, improving infant outcomes.
Area of Science:
- Neonatal care
- Public health policy
- Evidence-based practice
Background:
- International trend towards shorter postnatal hospital stays.
- Lack of evidence-based policies to guide earlier infant discharge.
- Need to assess the impact of early discharge on infant health outcomes.
Purpose of the Study:
- To evaluate the effects of early postnatal discharge on infant outcomes.
- To synthesize evidence from randomized controlled trials (RCTs) and interrupted time series (ITS) studies.
Main Methods:
- Systematic literature search across multiple databases (CENTRAL, Medline, Embase, CINAHL, SCI) up to January 2018.
- Inclusion of studies meeting Effective Practice and Organisation of Care criteria.
- Meta-analyses of RCTs using random effects models and reanalysis of ITS data.
Main Results:
- Infants discharged early (<48 hours vaginal, <96 hours cesarean) had higher readmission rates within 28 days (RR 1.70).
- Introduction of minimum postnatal stay policies correlated with a long-term reduction in neonatal readmissions.
- ITS meta-analyses showed a significant decrease in readmissions following policy implementation.
Conclusions:
- Early postnatal discharge is associated with an increased risk of infant readmission within 28 days.
- Minimum length of stay policies effectively reduce neonatal hospital readmission rates in the long term.
- Policy interventions are crucial for optimizing infant outcomes following birth.
Context:
Postnatal length of hospital stay has reduced internationally but evidence-based policies to support earlier discharge are lacking.
Objective:
To determine the effects of early postnatal discharge on infant outcomes.
Data Sources:
CENTRAL (Cochrane Central Register of Controlled Trials), Medline, Embase, Cumulative Index to Nursing and Allied Health Literature , and SCI (Science Citation Index) 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 (ITS) studies were extracted and reanalyzed in meta-analyses. Meta-analyses of randomized controlled trials (RCTs) used random effects models.
Results:
Of 9298 studies, 15 met the inclusion criteria. RCT meta-analyses revealed that infants discharged <48 hours after vaginal birth and <96 hours after cesarean birth were more likely to be readmitted to the hospital within 28 days compared to standard discharge (risk ratio: 1.70; 95% confidence interval [CI] 1.34 to 2.15). ITS meta-analyses revealed 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 to 0.60), with increasing impact in the first and second years (effect estimate: -4.27 [95% CI -7.91 to -0.63] and -6.23 [95% CI -10.15 to -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. The introduction of postnatal minimum length of stay policies was associated with a long-term reduction in neonatal hospital readmission rates.
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