Academic journal article Canadian Journal of Public Health

Increased Neonatal Readmission Rate Associated with Decreased Length of Hospital Stay at Birth in Canada

Academic journal article Canadian Journal of Public Health

Increased Neonatal Readmission Rate Associated with Decreased Length of Hospital Stay at Birth in Canada

Article excerpt

ABSTRACT

Purpose: To assess the potential impact of early post birth discharge in Canada.

Methods: Neonatal readmission was examined, based on hospital discharge data from the Canadian Institute For Health Information, with a total of 2,144,205 infants from fiscal year 1989/90 to fiscal year 1996/97.

Results: Neonatal readmission rates increased from 27.3 per 1,000 in 1989/90 to 38.0 per 1,000 in 1996/97, while mean length of hospital stay at birth decreased from 4.2 days to 2.7 days during the same period. The increase in readmission rate was more evident for dehydration and jaundice. The provinces and territories with decreased length of hospital stay at birth usually had increased neonatal readmission rate and earlier age at readmission. Between 1994/95 and 1996/97, compared with Newfoundland, the risks for neonatal readmission for dehydration were 5.7 and 5.5, and for jaundice were 4.5 and 2.7, respectively, for Alberta and Ontario.

Conclusion: Neonatal readmission rates for several conditions have increased substantially, associated with early post birth discharge policies adopted in Canada.

ABREGE But : Evaluer ;'impact potential des sorties precoces de l'hopital apres la naissance.

Methodolgie : Examen des readmissions neonatales a partir des donnees sur les sorties d'hopital fournies par l'Institut canadien d'information dur la sante, portant sur un total de 2 144 205 nouveau-nes, de l'annee civile 1989-- 1990 a l'annee civile 1996-1997.

Resultats : Les taux de readmission neonatale sont passes de 27,3 pour 1 000 en 1989-1990 a 38 pour 1 000 en 1996-1997 alors que la moyenne du sejour a l'hpital apres la naissance passait de 4,2 a 2,7 jours pendant la meme periode. L'augmentation du taux de readmission etait encore plus marque pour les cas de deshydratation et de jaunisse. Les provinces et les territoires pour lesquels il y avait diminution de la duree du sejour a l'hopital apres la naissance avaient habituellement des taux de readmission neonatale plus eleves, et l'age de readmission du nouveau-ne etait infreieur. Entre 1994-1995 et 1996-1997, en comparaison avec Terr-Neuve, les risques de readmission neonatale pour deshydratation etaient de 5,7 et de 5,5 respectivement pour l'Alberta et l'Ontario; pour la juanisse, ils etaient de 4,5 et 2,7 respectivement.

Conclusion : Les taux de readmission neonatale pour certaines affections ont substantiellement augment et sont associes a l'adoption au Canada de politiques autorisant des sorties precoces de l'hopital apres la naissance.

There is an increasing trend towards discharging newborn infants soon after birth. The proportion of newborns discharged within two days after birth increased dramatically from 2.8% in 1984 to 19.1% in 1994 in Canada.1 In Alberta, this proportion reached 33.5% in 1994.(1) This trend is based on the view that early discharge (i.e., within 48 h after birth) is safe for normal newborns, especially if community followup services are provided.2-6 Moreover, early discharge reduces the health care cost, and may contribute other benefits to the infants and their families.7

In a 1996 joint policy statement, the Canadian Paediatric Society and the Society for Obstetricians and Gynaecologists of Canada recommended that discharge of newborns less than 48 hours after birth is appropriate for full term (37 to 42 weeks) infants whose size is adequate for their gestational age and who have no medical complications.8 However, according to a previous study, the proportion of low birthweight (< 2500 g) newborns discharged within two days after birth in Canada also rose from 1.4% in 1984 to 6.1 % in 1994.(1) This proportion reached 14.9% in Alberta in 1994.(1)

Several studies have raised the concern that early discharge of newborns may be associated with an increased health risk.9-12 A recent study carried out in Ontario found that shorter hospital stay at birth was associated with increased neonatal readmission rates for several conditions that may not be manifest within 24-72 hours. …

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