![]() 17 Factors associated with perceptions of unreadiness for newborn discharge include first live birth, maternal history of chronic disease or illness after birth, in-hospital neonatal illness, intent to breastfeed, mothers with inadequate prenatal care and poor social support, and black non-Hispanic maternal race. However, perceptions of readiness or unreadiness at the time of discharge often differ among pediatricians, obstetricians, and mothers. Readiness for discharge of a healthy term infant is traditionally determined by pediatricians after a review of the mother's and family members' ability to provide care to a newborn infant at home. 11, 13, –, 16 Close follow-up and better coordination of postdischarge care were important factors in decreasing the readmission rates. 14, 15 Other frequently reported risk factors for readmission were Asian race, primiparity, associated maternal morbidities, shorter gestation or lower birth weight, instrumented vaginal delivery, male gender, and small size for gestational age. These studies identified jaundice, dehydration, and feeding difficulties as the most common reasons for readmission. In some of these studies the risk factors for readmission to identify infants who may benefit from either a longer hospital stay or close postdischarge follow-up were also evaluated. 7, 11, –, 14 However, the differences in the definition of early discharge, postdischarge follow-up and support, and the timing of readmissions make it difficult to compare the results. In these reports, readmissions after an early discharge varied from no increase to a significant increase. ![]() In several large epidemiologic studies, readmission rates were used to assess the adequacy of the newborn hospital length of stay. An inadequate assessment by health care providers in any of these areas before discharge can place an infant at risk and may result in readmission. 7, –, 10 Risk of ReadmissionĬriteria for newborn discharge include physiologic stability, family preparedness and competence to provide newborn care at home, availability of social support, and access to the health care system and resources. Several subsequent studies have reported that the postpartum-length-of-stay legislation has led to an increase in postpartum length of stay, but the impact of this increase in length of stay on the rate of neonatal readmissions has been inconsistent. 7 Early newborn discharge was implemented in the 1990s, but in response to the ensuing debate on the care and safety of mothers and their infants, most states and the US Congress enacted legislation that ensured hospital stay for up to 48 hours for a vaginal delivery and up to 96 hours after birth by cesarean delivery. 6 The average length of stay of the mother-infant dyad after delivery declined steadily from 1970 until the mid-1990s. 1 However, detection of significant jaundice, 2 ductal-dependant cardiac lesions, 3, 4 gastrointestinal obstruction, 5 and other problems may require a longer period of observation by skilled and experienced health care professionals. Many cardiopulmonary problems related to the transition from an intrauterine to an extrauterine environment usually become apparent during the first 12 hours after birth. The hospital stay of the mother and her healthy term newborn infant (mother-infant dyad) should be long enough to allow identification of early problems and to ensure that the family is able and prepared to care for the infant at home.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |