BACKGROUND AND PURPOSE:

• In an update to a 2002 review, Jones et al. (Cochrane Database of Systematic Reviews, 2021) assessed the effects of early postnatal discharge from hospital for healthy mothers

METHODS:

• Systematic review and meta-analysis
• Inclusion criteria
  • RCTs
  • Studies that compared early discharge from hospital with standard care
  • Participants were healthy mothers and term infants (≥37 weeks gestation and ≥2500 g)
• Study design
  • Certainty of evidence was assessed using GRADE criteria
• Primary outcomes
  • Admission for neonatal morbidity with 7 or 28 days
  • Maternal re-admissions within 6 weeks

RESULTS:

• 17 trials | 9409 women
  • The definition of early discharge varied from 6 hours to 4 to 5 days
  • Antenatal prep and home care also varied among trials
• Risk of bias was generally unclear due to insufficient reporting of trial methods
• Certainty of evidence is moderate to low

Infant Outcomes

• Early discharge probably slightly increases the number of infants readmitted within 28 days for neonatal morbidity (e.g. jaundice, dehydration, infections)
  • Relative risk (RR) 1.59 (95% CI, 1.27 to 1.98); 10 studies, moderate-certainty
• Risk of infant readmission
  • With early discharge: 69 per 1000 infants
  • With standard care: 43 per 1000 infants
• It is uncertain whether early discharge has any effect on the risk of infant mortality within 28 days
  • RR 0.39 (95% CI, 0.04 to 3.74); 4882 infants; 2 studies; low-certainty
• Early postnatal discharge probably makes little to no difference in the number of infants having at least one unscheduled medical consultation or contact with health professionals within the first four weeks after birth
  • RR 0.88 (95% CI, 0.67 to 1.16); 639 infants; 4 studies; moderate-certainty

Maternal outcomes

• Early discharge probably results in little to no difference in women readmitted within six weeks postpartum for complications related to childbirth
  • RR 1.12 (95% CI, 0.82 to 1.54); 6992 women; 11 studies; moderate-certainty
  • Wide confidence intervals indicate the possibility that the true effect may be an increase or reduction of risk
• Early discharge may result in little to no difference in the risk of depression within six months postpartum
  • RR 0.80 (95% CI, 0.46 to 1.42); 4333 women; 5 studies; low-certainty
  • Wide confidence intervals indicate the possibility that the true effect may be an increase or reduction of risk
• Early discharge probably results in little to no difference in women breastfeeding at six weeks postpartum
  • RR 1.04 (95% CI, 0.96 to 1.13); 7156 women; 10 studies; moderate-certainty
• Early discharge probably has little to no difference on the number of women having at least one unscheduled medical consultation or contact with health professionals
  • RR 0.72 (95% CI, 0.43 to 1.20); 464 women; 2 studies; moderate-certainty
• Maternal mortality within six weeks postpartum was not reported

Costs

• Early discharge may slightly reduce the costs of hospital care in the period immediately following the birth up to the time of discharge
  • Low-certainty, data not pooled
• Early discharge may have little to no difference on the costs of postnatal care following discharge, and up to six weeks after birth
  • Low-certainty, data not pooled

CONCLUSION:

• Because the definition of “early discharge” varied so widely between included trials, interpreting the evidence was challenging
• Early discharge probably increases the risk of neonatal admission for morbidity within 28 days
  • However, early discharge probably has no effect on the risk of maternal readmission
• Whether early discharge has an effect on mortality is unclear
• Early discharge may not have an effect on
  • Maternal postnatal depression
  • Breastfeeding success
  • Contact with healthcare professionals
  • Cost
• More evidence from large, well-designed trials is necessary
• One important limitation: Generalization may be limited because none of the evidence was derived from low-income countries

Learn More – Primary Sources:

Early postnatal discharge from hospital for healthy mothers and term infants

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