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Aug. 4, 2000 -- Going home from the hospital with your newborn is an exciting, emotional time. But a new survey reinforces the fear that checking out too soon can put some little ones at higher risk of dying within the first year of life from medical problems that are not always apparent in the first hours after birth.
In recent years, managed-care companies have put pressure on hospitals and doctors to send women home with their babies as soon as possible. Congress recently passed a law requiring insurers to allow women and their babies to stay in the hospital for 48 hours after a vaginal birth and 96 hours after a cesarean delivery. Nonetheless, many mothers and newborns continue to go home sooner.
"There is always pressure to get mothers out," says Moshe Ipp, MD, a pediatrician at the Hospital for Sick Children in Toronto. "But if the mother says she wants to go, the hospital will let them go unless feel there is a risk factor." In Canada, new moms may stay as long as 60 hours and the insurance company must pay for it.
How early is too early to go home with your baby? In the survey of women who gave birth in Washington State in 1989 and 1990, babies sent home within 30 hours were almost four times more likely to die of heart-related illnesses, and nearly five times more likely to die of infection within one year of birth, than infants discharged later. Infants discharged early were also 44% more likely to die of sudden infant death syndrome (SIDS) than those discharged later.
The survey's main author, Jesse D. Malkin, PhD, tells WebMD the study is the first to find an association between early discharge and deaths of any cause in newborns."We found a significantly increased risk of death among newborns with very short hospital stays," says Malkin, a researcher at Covance Health Economics and Outcomes Services in Gaithersburg, Md.
Heart-related problems can be tricky to diagnose and may not be apparent for several days after the baby is born. The same is true for some potentially dangerous infections.
In the survey, published in the August issue of the journal Obstetrics & Gynecology, babies of poorer mothers and mothers who had given birth previously were more likely to be sent home early. Early discharge was highest among Hispanic mothers and infants. Very late discharge (more than 78 hours after birth) was highest among babies born by cesarean section.
Of 155 deaths occurring in the first year of life, 66.5% were attributed to SIDS. In the past few years, the American Academy of Pediatrics has tried to educate mothers that putting babies to sleep on their backs can virtually eliminate the risk of SIDS.
"A shorter stay reduces the opportunity to train the mother in infant care during her hospital stay. And, to the extent that there is more education that would be lost now than previously, because of the 'Back to Sleep' campaign, we actually think our results may be even stronger today than they were 10 years ago. Today, with a longer stay, there would be more education and therefore we would expect a longer stay to have an even greater beneficial effect," Malkin tells WebMD.
Education is also a way to prevent two other important causes of readmission and death among newborn babies. Ipp says improper breastfeeding can lead to babies becoming dehydrated and jaundiced. Jaundiced babies have a yellowish tinge to their skin and the whites of their eyes. Mild jaundice may simply go away, but more serious cases can lead to death, Ipp says.
Teaching new moms proper nursing technique can minimize the risk of jaundice and dehydration. Another way to avoid problems is to delay discharge of a baby who is having obvious trouble nursing.
Suzanne Trupin, MD, agrees that maternal education is a major issue that has taken a back seat in the era of managed care.
"In the olden days, my patients would go for a get-acquainted visit with their pediatrician and go over certain issues. With managed care, nobody does that anymore. Even if you pick a pediatrician and go for a get-acquainted visit, [the hospital] has an assigned pediatrician on nursery call. So it doesn't matter who you pick, that pediatrician will see your baby," says Trupin, a clinical professor of obstetrics and gynecology at the University of Illinois College of Medicine at Urbana. "So they certainly are not going to give the mother as much direction about what to look for as they would [on a one-to-one basis]."
One important piece of advice to help minimize some of these problems: Parents-to-be should talk with their obstetricians, pediatricians, and other health care providers about caring for a newborn and infant. They should start the discussions during the pregnancy and learn as much as possible about parenting from the providers and from other sources of information.
作者： L.A.McKeown 2006-6-27