During the first six months of the pandemic, healthy newborns were discharged from hospitals faster, often after one midnight. In a new study in Pediatrics, Sara Handley and colleagues find that this shorter length of stay did not increase infant readmissions in the first week, suggesting that earlier discharge can be done safely.

The authors analyzed electronic health records on healthy, full-term newborns across 35 health systems, and compared data on infants born between March 1 to August 31, 2020 with those born at the same time of year in 2017, 2018, and 2019. They compared the percentage of newborns with shorter lengths of stay (defined as less than 2 midnights for vaginal births, and less than 3 midnights for cesarean births) and rehospitalization rates within seven days of discharge.

Their results were reassuring. During the pandemic, 43% of all healthy, full-term newborns had shorter hospital stays, up from 28.5% in earlier years. As shown in Table 1, shorter stays increased for both vaginal and cesarean deliveries. Despite the increase in shorter stays, infant rehospitalizations after seven days decreased slightly during the pandemic, going from 1.2% to 1.1%. This suggests that the shorter length of hospital stay was safe, at least for these healthy, full-term infants who were selected by the family and clinician to go home early.    

newborns with shorter hospital (LOS)
Early COVID-19
newborns with shorter hospital (LOS)
All full-term infants28.5%43.0%
Vaginal births25.6%39.3%
Cesarean births40.1%61.0%
Table 1. Percentage of newborns with shorter hospital length of stay (LOS).

A Natural Experiment

These pandemic-related changes represent a natural experiment of shorter lengths of stay for healthy newborns. How long infants should stay in the hospital is a matter of ongoing debate. The discharge recommendations from the American Academy of Pediatrics for healthy, term infants are based on individual characteristics, including maternal and infant health, home support systems, and access to follow-up care, not time. However, a wave of legislation in the1990s set mandatory minimum hospital lengths of stay for newborns and mothers after childbirth. The result was an increase in the length of time mothers and babies spent in U.S. hospitals and, so far, it is unclear whether these changes improved infant health. In 2008, the federal government finalized rules that health plans could not restrict maternity-related length of stay to less than 48 hours for a vaginal delivery or 96 hours for a cesarean section.

This research challenges us to consider when and under what circumstances some healthy, term infants can be discharged earlier. The authors studied just one outcome, and other important maternal and child health outcomes need to be studied as well. These results suggest that the quality of infant care during the hospital stay and post-discharge did not markedly decline in the context of shorter lengths of stay.  

The study, Birth Hospital Length of Stay and Rehospitalization During COVID-19, was published in Pediatrics on December 23, 2021. The authors include Sara C. Handley, Kieran Gallagher, Amy Breden, Eric Lindgren, Justin Y. Lo, Moeun Son, Daria Murosko, Kevin Dysart, Scott A. Lorch, Jay Greenspan, Jennifer F. Culhane, and Heather H. Burris.

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