Early Newborn Discharge and Death from Congenital Heart Disease

A number of publications have addressed the pitfalls of early newborn discharge. This report addresses the risk of early discharge of newborns (less than 2 days of age) and death from congenital heart disease. The authors examined data from the Baltimore-Washington Infant Study of 4,390 infants with congenital cardiovascular malformations (CCVM) recognized from 1981–1989. Only cases unrecognized prior to death and identified at autopsy or by death certificate were analyzed. Characteristics of these patients and sociodemographic features were examined.

Eighteen percent (790) of the 4,390 patients with CCVM died in the first year of life, and of the fatal cases 76 or 9.6% were not diagnosed until after death (ie, were identified by community search). In 45 of 69 infants (information not available for 7 patients), death was not anticipated. Overall, 1.7% (76/4390) of patients with CCVM died prior to recognition of the defect but only 1% (45/4390) of infants with CCVM died unexpectedly before diagnosis. The 76 patients with CCVM who died before diagnosis of the CCVM were more likely to have multiple …