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Thursday, May 7, 2009

Early postnatal discharge from hospital for healthy mothers and term infants

[Intervention Review]
Early postnatal discharge from hospital for healthy mothers and term infants

Stephanie Brown1, Rhonda Small2, Brenda Argus3, Peter G Davis4, Ann Krastev1

1Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Australia. 2Mother and Child Health Research , La Trobe University, Melbourne, Australia. 3Newborn Research Centre, Royal Women's Hospital, Parkville, Australia. 4Department of Paediatrics, Royal Women's Hospital, Parkville, Australia

Contact address: Stephanie Brown, Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Level 1, 369 Royal Pde, Parkville, Victoria, 3052, Australia. stephanie.brown@mcri.edu.au. (Editorial group: Cochrane Pregnancy and Childbirth Group.)

Cochrane Database of Systematic Reviews, Issue 2, 2009 (Status in this issue: New search for studies completed, conclusions not changed)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DOI: 10.1002/14651858.CD002958
This version first published online: 22 July 2002 in Issue 3, 2002. Last assessed as up-to-date: 30 November 2008. (Help document - Dates and Statuses explained).

This record should be cited as: Brown S, Small R, Argus B, Davis PG, Krastev A. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD002958. DOI: 10.1002/14651858.CD002958.
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Abstract

Background
Length of postnatal hospital stay has declined dramatically in the past thirty years. There is ongoing controversy concerning whether staying less time in hospital is harmful or beneficial.

Objectives
The objective of this review was to assess the safety, impact and effectiveness of a policy of early discharge for healthy mothers and term infants, with respect to the health and well-being of mothers and babies, satisfaction with postnatal care, overall costs of health care and broader impacts on families.

Search strategy
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE (1966 to December 2007), CINAHL (1982 to December 2007) and reference lists of articles.

Selection criteria
Randomized trials comparing early discharge from hospital of healthy mothers and term infants, of greater than or equal to 2500 grams, with standard care in the settings in which trials were conducted.

Data collection and analysis
Trial quality was assessed and data were abstracted independently by at least two review authors.

Main results
Ten trials (involving 4489 women) were identified . There was substantial variation in the definition of 'early discharge', and the extent of antenatal preparation and midwife home care following discharge offered to women in intervention and control groups.

Six trials recruited and randomized women in pregnancy, four randomized women following childbirth. Post randomization exclusions were high. Non-compliance with allocated treatment was frequent.

No statistically significant differences in infant or maternal readmissions were found in eight trials reporting data on these outcomes. Five trials showed either no significant difference or results favouring early discharge for the outcome of maternal depression, although only three used a well-validated standardized instrument. The results of eight trials showed that breastfeeding rates did not differ significantly between the early discharge group and the control group receiving standard care.

Authors' conclusions
The pooled trials have inadequate power to detect increases in rare outcomes, such as infant and maternal mortality or readmissions.

Policies of earlier postnatal discharge of healthy mothers and term infants do not appear to have adverse effects on breastfeeding or maternal depression when accompanied by a policy of offering women at least one nurse-midwife home visit post discharge.

Large well-designed trials of early discharge programs incorporating process evaluation to assess the uptake of co-interventions, and using standardized approaches to outcome assessment are needed.

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Plain language summary

Early postnatal discharge from hospital for healthy mothers and term infants
The length of time women spend in hospital after childbirth has fallen dramatically in many countries over the past 30 years. This review of trials compared the policy of early discharge after childbirth with standard length of stay and care at the time.

Early postnatal discharge of healthy mothers and term infants does not appear to have adverse effects on breastfeeding or maternal depression. However, the quality of the studies was generally poor. There are still too few participants in trials to determine the impact of early discharge on rare events, such as infant mortality. Further research is needed.

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