Study underscores risk of 'drive-through deliveries'
July 22, 1997
Web posted at: 10:10 p.m. EDT (0210 GMT)
From Correspondent Jeff Levine
WASHINGTON (CNN) -- A new study indicates that newborn babies taken home from the maternity ward too soon could wind up right back where they started: in the hospital.
The study, published in Wednesday's issue of The Journal
of the American Medical Association, found that healthy newborns who remain hospitalized for more than a day generally fare better than those who go home a few hours after birth.
The results could become a factor in the debate over a controversial trend in medicine in the United States: so-called drive-through deliveries, the tendency of cost-conscious hospitals to rush mothers home after the often-traumatic experience of giving birth.
The issue has prompted action from Congress. A 1996 federal law that takes effect next year requires insurance companies to pay for at least two days of hospitalization
for mother and child after a normal delivery.
"Discharging apparently well newborns from the hospital before approximately the third day of life ... is likely to result in moderately but not dramatically increased risks of hospital readmissions," according to an accompanying editorial by Dr. Paula Braveman of the University of California at San Francisco and others.
"We estimate that among healthy newborns at least eight of every 100 rehospitalizations within the first week of life may be attributable to early discharge or may be preventable if the risk of early discharge was eliminated," the study said.
In the study, 17 percent of newborns were discharged early. Two percent, or 6,444 out of 310,578 of newborns, developed subsequent medical problems severe enough to warrant rehospitalization within the first month of life.
Healthy newborns are vulnerable to several conditions that can require hospital treatment, including jaundice, dehydration and sepsis, a dangerous infection.
"In absolute terms it's a relatively small number, but rehospitalizations really only hit the tip of the iceberg in terms of problems associated with early discharge," said Dr. Lenna Liu of the University of Washington.
"I think that the decision for when a newborn and their family needs to go home is a mutual one that should be decided between the family and their provider. It's not a decision that administrators or managed care people should be making," Liu added.
The new research doesn't focus specifically on Health Maintenance Organizations, but many have linked the drive-through phenomenon with managed care's cost-cutting approach.
"There's been a perception that there is a rule in HMOs that patients need to go home in 24 hours of delivery," said Susan Pisano of the American Association of Health Plans. "Rather, the case is that each patient is assessed individually."
Doctors who take care of the newborns agree a long hospital stay isn't always necessary. "Its not 100 percent across the board. There are some women who are capable of going home in less than 48 hours," said Dr. Marciana Wilkderson of Columbia Hospital for Women.
"Our findings underscore the additional need for careful
assessment of newborns prior to discharge," the Washington team wrote.
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