The debate over the consequences and potential risks associated with the clinical practice of early hospital discharge (EHD) of term newborns (TNB) is a heated one. There are concerns about the safety of a practice that has been established without adequate scientific evaluation of health risks. In the past 40 years, due to many medical and socio-economic improvements, neonatal dehydration has been seen infrequently in TNB in first world countries. Recently case reports of severe neonatal dehydration have been presented in association with EHD. California (CA), one of the most populous states in the USA, has been a leader in EHD. The purpose of this study is to evaluate if the clinical practice of EHD (<24hrs) is associated with an increase in readmissions for dehydration in CA. We analyzed data from all births in CA from computerized HD records provided by the Office of Statewide Health Planning and Development for the years 1983 and 1991 (the most recent year with complete available data) and compared the number of live births, EHD and readmissions for dehydration in TNB (International Code of Diseases 276.0, 276.1, 276.5, and 775.5). Findings are shown in theTable. Even with a 19% decrease in the prevalence of readmissions due to dehydration after EHD in TNB, and contrary to what could be expected, many more CA infants were readmitted due to dehydration in 1991 than in 1983. The almost threefold increase in readmissions for dehydration is associated with the large increase in EHD. We conclude that in developed areas where most common risk factors have been eradicated, a new high risk factor for rehospitalization of TNB due to dehydration has emerged: hospital discharge within 24hrs of delivery.
