Molecular Pharmacology: Enzyme Pair Joins Fight Against Drug-resistant Bacteria Disease Profiling: Gene Expression Pattern Predicts Potential for Tumor Metastasis Ambulatory Care: Hospital Length of Stay May Not Affect Newborns' Health   Alcohol Gives Broad Protection Against Heart Attack Modified AIDS Vaccine Shows Heightened Immunity in Mice Mouse Model Enables Research on Rare Tumor, Other Cancers Method Captures Early Culprit in Alzheimer's   Freeman and ICOHRTA Fellows Announced in Department of Social Medicine The Academy at HMS Honors Innovation Postdoc Fellowship at HSPH Renamed After Alonzo Smythe Yerby Cell Press Journals Now Available on Digital Library JFK/UMass Shuttle Now Permanent HMS Faculty Council 2002-2003 Honors and Advances News Briefs In Memoriam: Martin Berezin   Asthma Program Seeks Balanced Partnership with Community   New Law Limits Actions Over Vaccine Preservative   Front Page

AMBULATORY CARE Hospital Length of Stay May Not Affect Newborns' Health Six years after the U.S. Congress and 41 states established a 48-hour minimum hospital stay following normal vaginal delivery, a new study by researchers at the HMS-Harvard Pilgrim Health Care Department of Ambulatory Care and Prevention challenges the popular assumption that early hospital discharge after birth is harmful to newborns. A recent study by Jeanne Madden, Stephen Soumerai, Dennis Ross-Degnan, Tracy Lieu (clockwise from left), and colleagues found that shorter hospital stays for newborns do not necessarily compromise the infants' health. (Photo by Graham Ramsay) "The study tends to refute the premise that reduced maternity length of stay is harmful to infants and that state laws against early discharge would improve health outcomes," said lead author Jeanne Madden, a research fellow in the department. The study, which appears in the Dec. 19 New England Journal of Medicine, could add a new dimension to current policy debates about appropriate ways to regulate health care and the trade-offs among recommended clinical services at key points in a newborn's development. Madden and colleagues in the department and at Children's Hospital used seven and a half years of data on 20,366 mother-infant pairs with normal vaginal deliveries within a large Massachusetts health maintenance organization to determine the effects of reductions by the HMO in the postpartum length of stay and a subsequent state law establishing a minimum stay. The investigators measured the effects on length of hospital stay, follow-up care for newborns, use of outpatient care and hospital-based services during the first 10 days of life, and expenditures for hospital and home-based maternity services. "The study tends to refute the premise that reduced maternity length of stay is harmful to infants and that state laws against early discharge would improve health outcomes." --Jeanne Madden "To our knowledge, this is the best-controlled investigation to date comparing different maternity discharge policies and the first comprehensive study of the impact of legislation guaranteeing minimum stays," said Stephen Soumerai, professor and principal investigator of the study. Regardless of hospital length of stay, evidence-based recommendations in the clinical literature advise examining newborns on the third or fourth day after birth, when common problems such as jaundice and breastfeeding difficulties tend to peak. The HMS study found the rate of newborn examinations on the third or fourth day after birth increased from 24.5 percent to 65.6 percent after the HMO initiated a reduced-stay program, but dropped to 53.0 percent following the state's minimum length-of-stay mandate, which established no follow-up care schedule. "These changes primarily reflect changes in the rate of home visits," said lead author Madden. Although the rate of nonurgent visits to a health care center increased from 33.4 percent to 44.7 percent after the reduced-stay program was implemented, the study found no significant changes in the rate of emergency department visits or rehospitalizations. "Several studies have suggested that short stays are associated with an increased risk of death or readmission of the infant, whereas others have found no effect," Madden said. "In the setting we studied, we found neither policy appeared to affect the health outcomes of newborns. But after coverage for longer stays was guaranteed by law, newborns were less likely to be examined as recommended on day 3 or 4." Also flying in the face of popular assumptions, data from the study showed the health plan's average per-delivery expenses decreased only $90 when it began its reduced postpartum length-of-stay policy. "Added home services and shifts in prices for hospitalization were the factors that combined to thwart expected savings," Madden said. Funding for this study was provided by the federal Agency for Healthcare Research and Quality, the Harvard Pilgrim Health Care Foundation, and the federal Maternal and Child Health Bureau. --Judith Montminy