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US warns against early discharge of babies

BMJ 1995; 311 doi: (Published 21 October 1995) Cite this as: BMJ 1995;311:1041

American paediatricians last week warned that the trend toward ever shorter hospital stays for mothers and newborn babies may be dangerous. The American Academy of Pediatrics, which represents 49000 paediatricians, said that women should stay in hospital with their babies for at least 48 hours.

In the past two years health insurers have been placing pressure on hospitals and doctors to discharge new mothers and babies within 24 and even 12 hours after normal deliveries. The reaction by patients, doctors, and hospitals has prompted three states—Maryland, New Jersey, and North Carolina—to pass laws that bar discharge before 24 hours in most cases. Eleven other states are considering such laws.

Spokespeople for health insurers have pointed out that complications from early discharge are rare, especially when early discharges are followed up within a day by a nurse who visits new parents' homes. But the paediatric academy, in its practice guidelines published in the October issue of its journal, Pediatrics, identifies 16 conditions that should be met before discharge and says that meeting them usually takes at least 48 hours in hospital. They include an absence of medical complications, the completion of at least two feeds, successful urination and defecation by the baby, counselling of the mother about feeding and infant safety, and an assessment of the mother's drug and alcohol use and social support network. “The fact that a short hospital stay can be accomplished does not mean it is appropriate for every mother and infant.”

The paediatricians' guidelines echo a recent report by the American College of Obstetricians and Gynecologists. Both groups say that insurers are risking mothers' and children's health in attempts to cut costs and that decisions on lengths of stay in hospital should be made by doctors and patients.

But insurers have denied that they are usurping those decisions, and they have cited numerous studies that show no higher mortality from early discharge. “I am not aware that there is a policy out there where they refuse to pay after 24 hours,” a spokesperson for the insurance industry told the Associated Press last week.—JOHN ROBERTS, North American editor, BMJ

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