Galbraith Alison A, Egerter Susan A, Marchi Kristen S, Chavez Gilberto, Braveman Paula A
Robert Wood Johnson Clinical Scholars Program, University of Washington, Seattle, Washington 98195-7183, USA.
Pediatrics. 2003 Feb;111(2):364-71. doi: 10.1542/peds.111.2.364.
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.
To describe rates of early discharge and of timely follow-up for early-discharged newborns.
Retrospective, population-based cohort study using a 1999 postpartum survey in California.
A total of 2828 infants of mothers with medically low-risk singleton births.
Rates of early discharge (<or=1-night stay after vaginal delivery and <or=3-night stay after cesarean section) and untimely follow-up (no home or office visit within 2 days of early discharge).
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 <or=100% 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 <or=100% 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]).
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.
为回应安全担忧，联邦和州立法规定了最低产后住院时长，加利福尼亚州的州立法规定了早出院后随访的覆盖范围。对于新生儿正在接受的产后服务知之甚少。
描述早出院率以及早出院新生儿的及时随访率。
使用1999年加利福尼亚州产后调查进行的基于人群的回顾性队列研究。
共有2828名单胎出生且母亲医学风险较低的婴儿。
早出院率（阴道分娩后住院≤1晚，剖宫产术后住院≤3晚）和随访不及时率（早出院后2天内未进行家访或门诊访视）。
总体而言，49.4%的新生儿早出院。其中，67.5%的新生儿随访不及时。收入越低，早出院的几率越大：收入≤贫困线100%的调整优势比（AOR）（及95%置信区间）为2.06（1.50 - 2.83），收入为贫困线101% - 200%的调整优势比为2.20（1.65 - 2.93），收入为贫困线201% - 300%的调整优势比为2.24（1.63 - 3.08）。收入≤贫困线100%的产妇所生婴儿（AOR = 1.89 [1.13 - 3.17]）以及收入为贫困线201% - 300%的产妇所生婴儿（AOR = 1.78 [1.09 - 2.91]）、享受医疗补助（AOR = 1.73 [1.20 - 2.47]）、拉丁裔种族（AOR = 1.47 [1.02 - 2.14]）和非英语母语（AOR = 1.72 [1.16 - 2.55]）的婴儿随访不及时的可能性更大。
尽管立法后短期住院情况明显减少，但许多新生儿——尤其是低收入家庭的新生儿——仍继续早出院。大多数早出院的新生儿——尤其是那些享受医疗补助的新生儿以及来自低收入、拉丁裔和非英语家庭的新生儿——未接受推荐的随访。社会经济状况最脆弱的新生儿接受的产后服务较少。
