Newborn early discharge revisited: Are California newborns receiving recommended postnatal services?

Context. Responding to safety concerns, federal and state legislation mandated coverage of minimum postnatal stays and state legislation in California mandated coverage of follow-up after early discharge. Little is known about the postnatal services newborns are receiving. Objective. To describe rates of early discharge and of timely follow-up for early-discharged newborns. Design and Setting. Retrospective, population-based cohort study using a 1999 postpartum survey in California. Participants. A total of 2828 infants of mothers with medically low-risk singleton births. Main Outcome Measures. Rates of early discharge (less than or equal to1-night stay after vaginal delivery and less than or equal to3-night stay after cesarean section) and untimely follow-up (no home or office visit within 2 days of early discharge). Results. Overall, 49.4% of newborns were discharged early. Of these, 67.5% had untimely follow-up. The odds of early discharge were greater with lower incomes: the adjusted odds ratios (AORs) (with 95% confidence intervals) were 2.06 (1.50-2.83) for incomes less than or equal to100% of poverty, 2.20 (1.65-2.93) for incomes from 101%-200% of poverty, and 2.24 (1.63-3.08) for incomes from 201%-300% of poverty. Untimely follow-up was more likely for infants of women with incomes less than or equal to100% of poverty (AOR=1.89 [1.13-3.17]) and 201%-300% of poverty (AOR=1.78 [1.09-2.91]), Medicaid coverage (AOR=1.73 [1.20-2.47]), Latina ethnicity (AOR=1.47 [1.02-2.14]), and non-English language (AOR=1.72 [1.16-2.55]). Conclusions. Despite an apparent decline in short stays after legislation, many newborns-particularly from lower-income families-continue to be discharged early. Most newborns discharged early-particularly those with Medicaid and those from low-income, Latina, and non-English- speaking homes-do not receive recommended follow-up. The most socioeconomically vulnerable newborns are receiving fewer postnatal services.