Pediatric Academic Societies Abstracts for 2001

NEWBORN HOSPITAL DISCHARGE PRACTICES OF PEDIATRICIANS: RESULTS FROM A NATIONAL SURVEY A Baker MS, C Spino DSc, E Slora PhD, J Britton MD, PhD, and H Bernstein DO. Pediatric Research in Office Settings (PROS), American Academy of Pediatrics, Elk Grove Village, IL; Independent Statistician, Ann Arbor, MI; Scottsdale, AZ and General Pediatrics, Children's Hospital, Boston, MA. Accepted for a poster symposium presentation at the 2001 Pediatric Academic Societies? Annual Meeting.

OBJECTIVE: To identify practice/physician characteristics that influence pediatricians' self-reported newborn discharge practices.

DESIGN/METHODS: Of the pediatricians randomly surveyed through the national 1999-2000 AAP Periodic Survey, 490 were identified as routinely providing care for newborns in the nursery. These respondents rated the importance of 22 infant, maternal, and peripartum factors in determining readiness for nursery discharge on a 5-pt Likert scale, and reported their perceptions of optimal and minimal lengths of stay (LOS) for healthy term newborns. Importance of readiness factors was dichotomized as "high" (very important or important) versus "low" (neither, unimportant, or very unimportant). Relationships between pediatricians' responses and demographic information were explored using multivariate logistic regression (adjusted odds ratios are presented).

RESULTS: Most pediatricians (minimum 81%) rated all seven infant clinical factors (eg, stable, normal vital signs; successful feeding) as highly important determinants of discharge readiness. Women were 2-3 times more likely to rate maternal and peripartum factors such as maternal fatigue and stress, demonstration of maternal skills, breastfeeding knowledge or experience, adequacy of social support, maternal age <18 years, and low income/lack of financial resources as highly important (p <.05 for all comparisons). With respect to lengths of hospital stay, women were twice as likely to identify an optimal LOS as > 36 hours (p<.05) and a minimal LOS as > 24 hours (p<.01). Pediatricians in group settings were three times as likely as those in solo or 2-physician practices to advocate an optimal LOS >36 hours (p<.01), and those with a high proportion of publicly insured or uninsured patients were less likely to identify an optimal LOS as >36 hours (OR=0.53, p<.05).

CONCLUSIONS: Female pediatricians report a more biopsychosocial approach to determining discharge readiness than their male counterparts, taking into account infant characteristics, maternal skills, and socioemotional issues that may affect the mother/infant pair's adjustment at home. The finding that those providing care for the most financially vulnerable patients do not see the need for longer LOS is both surprising and of concern. The results support the need for a prospective critical examination of perinatal hospital discharge practices, such as the PROS Life Around Newborn Discharge Study.