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December 17, 1997

Early Discharge of Newborns-Reply

Author Affiliations

University of Wisconsin Madison

JAMA. 1997;278(23):2066-2067. doi:10.1001/jama.1997.03550230042032

In Reply  —We believe that meaningful discussion about the neonatal effects of early postpartum discharge should be based on carefully specified outcomes and agree with Drs Cass and Volk that any associated risks should be quantified in a clinically interpretable fashion. The manuscript we originally submitted to JAMA included an economic interpretation of readmission risk based on NNT, but this analysis was deleted as a result of an editorial decision.Briefly, our analysis was based on the observed rates of early (days 1-2) discharge and feeding-related readmissions in the study cohort. We conservatively applied the upper 95% CI for the crude case-control OR (1.7) to estimate the maximal absolute increase in readmission risk associated with early discharge. We then used standard methods1 to estimate that prevention of a single readmission would require an additional postpartum hospital day for at least 866 well newborns. Based on Wisconsin hospital costs for routine postpartum