Early discharge after normal delivery has become a standard of care in many HMOs and health care networks in order to contain cost. Recent federal legislation highlights concern over this policy. Early discharge (≤ 48 hrs) and selective home health follow-up are routine at UCSD. To identify risk factors for neonatal readmission, we retrospectively compared records of 56 infants readmitted from 1/95 to 10/96 at ≤ 14 days of age with a cohort of 207 controls matched for date of birth. Infants with congenital abnormalities, positive toxicology screens, maternal age ≤18 yrs, complicated neonatal courses or multifetal gestations were excluded from consideration.

Results: Cases and controls were similar in maternal age (28 yrs), gravidity (2), and parity (2), delivery mode (83% vaginal), gender (60 vs 50% male), and age of newborn discharge (32 vs 30 hrs). By univariate analysis, cases had slightly lower mean birth weights (3344 vs 3490g, p=.04), and were more likely to be Hispanic (65 vs 45%, p=.025), and have home health follow-up (50 vs 29%, p=.008). Mothers of readmitted neonates also had a higher rate of intention to breast feed (98 vs 83%, p=.05). Mean gestational ages were similar (38.8 vs 39.3 wks, p=.07), although cases were more likely to be 35-37 wks gestation (33 vs 13%, p=.0006). A greater proportion of cases had public funding (75 vs 61%, p=.08). By multivariate logistic regression, higher birth weight decreased the risk of readmission (OR=0.99, 95% CI.998-.999, p=.023) whereas gestational age 35-37 wks (OR=1.6, 95% CI 1.02-2.48, p=.025), intent to supplement breast feeding with formula (OR 3.56, CI 1.07-11.92, p=.039), and home health follow-up (OR=1.5, CI 1.02-2.09, p=.038) increased readmission risk.

Summary: Lower birthweight, borderline prematurity, supplemented breast feeding and home health follow-up were independently associated with rehospitalization. Newborn age at discharge per se was not associated with neonatal readmission. Speculation: A pre-discharge, risk based model may focus post-discharge assessment and interventions, such as home health visits, thereby reducing costly readmissions.