But was it the right thing? When Congress passed the Motherhood Act last year, little was known about how early discharge affects children’s health. Researchers have now completed two large studies that address the issue directly, and the results may come as a surprise. Though one study suggests that ““short stay’’ babies are slightly more likely to land back in the hospital, both make clear that the length of a child’s hospital stay has little effect on her health. In other words, Congress may have shot the wrong target.
At a glance, the new studies appear to contradict each other. In analyzing the medical records of some 10,000 newborns, University of Washington researchers found that those sent home within 30 hours of birth were 28 percent more likely to be readmitted within a week and 12 percent more likely to return within a month. The Seattle researchers looked at all readmissions, regardless of what prompted them. But in a separate study, appearing in the same issue of The Journal of the American Medical Association, researchers at the University of Wisconsin focused specifically on feeding-related problems. If a new mom lacks experience with nursing, getting her baby fully nourished can require some coaching. Since hospital caregivers can provide that coaching, the Wisconsin researchers figured that feeding problems would be the greatest hazard to short-stay babies. But when they analyzed the records of 200 kids who were hospitalized for feeding-related problems, such as dehydration and poor weight gain, early discharge didn’t emerge as a risk factor. The data showed that breast-fed babies were at far greater risk than bottle-fed babies, especially if their moms had never nursed before. Poverty and prematurity also heightened the risk. But the length of a child’s initial hospital stay made virtually no difference. Though Wisconsin’s early-discharge rate tripled during the course of the study - from 17 percent in 1991 to 52 percent in 1994 - the rate of feeding-related hospital admissions rose by just three one-hundredths of a percent.
While the two studies yielded different findings, the scientists who conducted them insist they hold the same lesson. Even if babies who leave the hospital early do incur the slight risk the Seattle researchers detected, early discharge is not a major danger. As the new studies make clear, inexperience is the main cause of preventable health problems. Keeping babies in the hospital for several days is one way to combat that problem, but not a very efficient one. ““If I had to choose between a 48-hour hospital stay and a follow-up house call from a nurse,’’ says Dr. Bruce Edmonson of the Wisconsin team, ““I’d take the follow-up any day.''
Are today’s newborns getting good follow-up care? The American Academy of Pediatrics recommends that babies sent home during the first two days of life be seen by a health professional within 48 hours of discharge. But when Dr. M. Jeffrey Maisels, a neonatologist in Royal Oak, Mich., surveyed 20 pediatric practices, he found that seven in 10 short-stay infants had to wait longer than that. A third of them had to wait more than two weeks. The Motherhood Act will mandate billions of dollars’ worth of potentially useless hospital stays. Ironically, it says nothing about what happens when they’re over.
Roughly one newborn in 50 ends up back in the hospital during the first month of life. Some leading casues of readmission:
40% Juaundice - Yellowing of the skin and eyes due to buildup of a bile pigment 25% Suspected infection - Pneumonia, eye inflammation, unexplained fevers 5% Feeding-related problems - Can lead to dehydration if not promptly treated 5% Respiratory problems - Baby turn blue or momentaily stops breathing 5% Gastrointestinal problems - Vomiting, bowel obstruction 2% Heart problems - Irregular pulse, heart murmur, congenital malformations 2% Injury - Includes accidents, abuse, choking, poisoning Source: M. bruce Edmonson, M.D., Univ. of Wis., Madison
