Early Postnatal Discharge for Infants: A Meta-analysis

Abstract

OBJECTIVES:To describe the proportion of children screened by the Modified Checklist for Autism in Toddlers (M-CHAT), identify characteristics associated with screen completion, and examine associations between autism spectrum disorder (ASD) screening and later ASD diagnosis. METHODS:We examined data from children attending 18-and 24-month visits between 2013 and 2016 from 20 clinics within a health care system for evidence of screening with the M-CHAT and subsequent coding of ASD diagnosis at age .4.75 years. We interviewed providers for information about usual methods of M-CHAT scoring and ASD referral.RESULTS: Of 36 233 toddlers, 73% were screened and 1.4% were later diagnosed with ASD. Hispanic children were less likely to be screened (adjusted prevalence ratio [APR]: 0.95, 95% confidence interval [CI]: 0.92-0.98), and family physicians were less likely to screen (APR: 0.12, 95% CI: 0.09-0.15). Compared with unscreened children, screen-positive children were more likely to be diagnosed with ASD (APR: 10.3, 95% CI: 7.6-14.1) and were diagnosed younger (38.5 vs 48.5 months, P , .001). The M-CHAT's sensitivity for ASD diagnosis was 33.1%, and the positive predictive value was 17.8%. Providers routinely omitted the M-CHAT follow-up interview and had uneven referral patterns.CONCLUSIONS: A majority of children were screened for ASD, but disparities exist among those screened. Benefits for screen-positive children are improved detection and younger age of diagnosis. Performance of the M-CHAT can be improved in real-world health care settings by administering screens with fidelity and facilitating timely ASD evaluations for screen-positive children. Providers should continue to monitor for signs of ASD in screen-negative children.WHAT'S KNOWN ON THIS SUBJECT: Universal autism screening in toddlers is recommended, but it is unknown how frequently this occurs, what factors are associated with screening, and the performance characteristics of the most commonly used screening instrument in real-world health care settings.WHAT THIS STUDY ADDS: Autism screening was completed in the majority of toddlers but was less likely to occur in Hispanic children. Children who screened positive were more likely to be diagnosed with autism and were diagnosed earlier, but falsenegative screens were common.

Birth Hospital Length of Stay and Rehospitalization During COVID-19

“…Previous research, including systematic reviews, have reported varied results with respect to early discharge and infant rehospitalization. 10,[34][35][36] A recent meta-analysis, which included RCTs and quasi-experimental studies, and Cochrane review, both report an association between early hospital discharge (<48 hours for vaginal and <96 hours for cesarean) and infant readmission within 28 days. 10,36 However, findings from both studies are driven (87.6% and 74% weight, respectively) by a single center Egyptian RCT.…”

“…10,[34][35][36] A recent meta-analysis, which included RCTs and quasi-experimental studies, and Cochrane review, both report an association between early hospital discharge (<48 hours for vaginal and <96 hours for cesarean) and infant readmission within 28 days. 10,36 However, findings from both studies are driven (87.6% and 74% weight, respectively) by a single center Egyptian RCT. 37 In general, findings from RCTs are limited by the application of highly restrictive criteria for early discharge, inadequate sample sizes to detect clinical effects, and variation in post-discharge services.…”

Early Discharge from a Newborn Nursery in the United States during the COVID-19 Pandemic

“…During the COVID-19 era, data from U.S. healthcare systems discussed above showed that early discharge has not been shown to increase readmissions; in fact, a decrease in readmissions has been observed [22,23]. The reason for this is unclear, and contradicts the findings of a pre-pandemic meta-analysis which found infants discharged early were more likely to be readmitted within 28 days [2]. In the meta-analysis, early was defined as less than 48 h for vaginal and 96 h for cesarean delivery, which exceeds the average postnatal LOS in several developed countries [2,18].…”

“…The authors concluded that early discharge probably leads to a higher risk of infant readmission within 28 days of birth [17]. A 2020 meta-analysis by Jones et al pooled readmission data from seven randomized controlled studies and found that infants discharged early were more likely to be readmitted within 28 days compared to standard discharge [2].…”

“…Early discharge of a newborn infant has been shown in some studies to be associated with increased risk of readmission [1][2][3][4]. In 2004, the American Academy of Pediatrics (AAP) in the United States (U.S.) defined early discharge as less than or equal to 48 h [5].…”