Grand Rounds

Cochrane Update: Does Early Discharge After Birth Increase Readmission?

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

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

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

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

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

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

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

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