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June 19, 1996


Author Affiliations

The Johns Hopkins University School of Medicine, Baltimore, Md

JAMA. 1996;275(23):1823-1824. doi:10.1001/jama.1996.03530470051030

Health care for newborns is under close scrutiny in this unsettling era of health system reform. Length of hospital stay for mothers and their newborns continues to shorten, antenatal corticosteroids improve outcome for premature infants and decrease overall costs, and survival of infants born at less than 25 weeks of gestation has improved, but morbidity is high, causing many to question the cost-effectiveness of advanced technologies.

Ironically, early discharge after birth originally was demanded by women who wanted alternatives to a "standard" hospital delivery.1 In 1980, the American Academy of Pediatrics (AAP) defined "early discharge" as a stay of 48 hours after an uncomplicated vaginal delivery and "very early discharge" as a stay of less than 24 hours. Eligibility guidelines were outlined as uncomplicated full-term pregnancy with good prenatal care, follow-up care arranged, and desire for early discharge. Subsequently, health insurers began to seek significant cost savings by refusing