The impact of early obstetric discharge on newborn health care

Current Opinion in Pediatrics

Volumn 8, Issue 2, 1996, Pages 96-101

  Lee, Kyong Soon ^a   Perlman, Max ^a  

^a ST JOSEPH S HOSPITAL   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

DELIVERY; DISEASE SEVERITY; HOSPITAL DISCHARGE; HUMAN; JAUNDICE; LENGTH OF STAY; NEWBORN; NEWBORN CARE; NEWBORN SCREENING; PHENYLKETONURIA; PRIORITY JOURNAL; REVIEW;

EID: 0029876991     PISSN: 10408703     EISSN: None     Source Type: Journal    
DOI: 10.1097/00008480-199604000-00002     Document Type: Review

References (42)

1. Guerriero WF: A maternal welfare program for New Orleans. Am J Obstet Gynecol 1943, 46:312-313.
2. Theobald GW: Home on the second day: the Bradford experiment. BMJ Dec 19, 1959:1364-1367.
3. Yanover MJ, Jones D, Miller MD: Perinatal care of low-risk mothers and infants: early discharge with home care. N Engl J Med 1976, 294:702-705.
4. Kemper K, Forsyth B, McCarthy P: Persistent perceptions of vulnerability following neonatal jaundice. Am J Dis Child 1990, 144:238-241.
5. Braveman P, Egerter S, Pearl M, Marchi K, Miller C: Early discharge of newborns and mothers: a critical review of the literature. Pediatrics 1995, 96:716-726. Provides a complete and critical review of English-language literature on early discharge. The review classifies studies by age at discharge and the number of postdischarge services provided. They conclude that "published evidence provides little knowledge of the consequences of short maternal/newborn hospital stays or varying postdischarge practices for the general population."
6. Beck CT, Reynolds MA, Rutowski P: Maternity blues and postpartum depression. J Obstet Gynecol Neonatal Nurs 1992, 21:287-293.
7. Pittard WB III, Geddes KM: Newborn hospitalization: a closer look. J Pediatr 1988, 112:257-261.
8. Strong TH, Brown WL Jr, Brown WI, Curry CM: Experience with early postcesarean hospital dismissal. Am J Obstet Gynecol 1993, 169:116-119.
9. Carty EM, Bradley CF: A randomized, controlled evaluation of early postpartum hospital discharge. Birth 1990, 17:199-204.
10. Waldenstrom U, Sundelin C, Lindmark G: Early and late discharge after hospital birth: health of mother and infant in the postpartum period. Ups J Med Sci 1987, 92:301-314.
11. Britton JR, Britton HL, Beebe SA: Early discharge of the term newborn: a continued dilemma. Pediatrics 1994, 94:291-295. This review of the literature on early discharge concludes that studies on early discharge are heterogeneous, with limitations of methodology and study design, which limits the validity of the conclusion that early discharge is safe.
12. Arthurton MW, Bamford FN: Paediatric aspects of early discharge of maternity patients. BMJ Aug 26, 1967:517-520.
13. Hellman LM, Kohl SG, Palmer J: Early hospital discharge in Obstetrics. Lancet 1962, i:228-232.
14. Dying for milk: some mothers, trying in vain to breast-feed, starve their infants. The Wall Street Journal, July 22, 1994.
15. Kessel W, Kiely M, Nora AH, Sumaya CV: Early discharge: in the end, it is judgment Pediatrics 1995, 96:739-742.
16. Wallace HM, Micik S, Wise P: Community study of infant mortality in San Diego County. J Trop Pediatr 1994, 40:172-179.
17. Schwartz R: Short Stay Hospitalization for Mother and Newborns: Concerns and Issues. Providence, RI: The National Perinatal Information Center; 1995.
18. Catz C, Hanson JW, Simpson L, Yaffe J: Summary of workshop: early discharge and neonatal hyperbilirubinemia. Pediatrics 1995, 96:743-745.
19. Lee K-S, Perlman M, Ballantyne M, Elliott I, To T: Association between duration of neonatal hospital stay and readmission rate. J Pediatr 1995, 127:758-766. This population-based study from Ontario quantified the increase in readmission rate associated with shorter hospital stay. The study reported on changes in an uncontrolled setting where early discharge was occurring without strict selection criteria and without standardized follow-up. Readmission rates were increased for jaundice and dehydration. This study is of note in that all healthy newborns in one region were included, and it addresses a major limitation of earlier studies by using a large sample size to examine relatively rare outcomes. The study suggests that severity of illness of readmissions for jaundice and dehydration in one hospital also increased.
20. Seidman DS, Stevenson DK, Ergaz Z, Gale R: Hospital readmission due to neonatal hyperbilirubinemia. Pediatrics 1995, 96:727-729.
21. American Academy of Pediatrics, Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia: Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics 1994, 94:558-565. Provides practical guidelines for the management of hyperbilirubinemia in healthy full-term newborns based on evidence available and derived from consensus when data are lacking.
22. Maisels MJ, Newman TB: Kernicterus in otherwise healthy, breast-fed term newborns. Pediatrics 1995, 96:730-733. Although nonhemolytic causes of hyperbilirubinemia were previously thought not to cause kernicterus, the authors document that, rarely, classic kernicterus can occur in apparently healthy, full-term breastfed newborns who do not have hemolytic disease or any other known cause for their jaundice. The authors state that there is no reliable method for identifying these infants in the early neonatal period, and that closer follow-up after birth may have prevented some of the outcomes. Five of six infants were of borderline full-term gestational age at 37 to 38 weeks.
23. Stevenson DK, Vreman HJ, Oh W: Bilirubin production in healthy term infants as measured by carbon monoxide in breath. Clin Chem 1994, 40:1934-1939.
24. MacDonald MG: Hidden risks: early discharge and bilirubin toxicity due to glucose-6-phosphate dehydrogenase deficiency. Pediatrics 1995, 96:734-738. Describes four cases of kernicterus from glucose-6-phosphate dehydrogenase deficiency in infants aged less than 48 hours at hospital discharge, where appropriate follow-up was not provided. These cases are compared with four cases of jaundice from glucose-6-phosphate dehydrogenase in infants aged more than 2 days at discharge, in whom glucose-6-phosphate dehydrogenase was identified and who were closely monitored after discharge. With close follow-up, the maximum bilirubin level was less than 21 mg/dL with no kernicterus, whereas infants without close follow-up presented at 5 days with high bilirubin levels (> 600 mg/dL) and developed kernicterus. The author stresses the importance of detailed family history for occult ethnic risk factors for glucose-6-phosphate dehydrogenase deficiency, and the need for adequate and timely follow-up.
25. Conrad PD, Wilkening RB, Rosenberg AA: Safety of newborn discharge in less than 36 hours in an indigent population. Am J Dis Child 1989, 143:98-101.
26. Cooper WO, Atherton HD, Kahana M, Kotagal UR: Increased incidence of severe breast-feeding malnutrition and hypernatremia in a metropolitan area. Pediatrics 1995, 96:957-960. Case series of five newborn infants discharged at 48 hours or less who developed severe breastfeeding malnutrition and hypernatremia, which resulted in long-term morbidity. The authors speculate that inadequate parent education about breastfeeding and inadequate strategies for infant follow-up may have contributed to the problem. Of note, all mothers read literature, and three of five contacted either a lactation consultant, home health nurse, or physician, but none visited the pediatrician. Mothers were primiparous, breastfeeding, aged between 28 and 38 years, and reported extensive preparation for breastfeeding.
27. Britton HL, Britton JR: Efficacy of early newborn discharge in a middle-class population. Am J Dis Child 1984, 138:1041-1046.
28. Waldenstrom U, Sundelin C, Lindmark G: Early and late discharge after hospital birth: breast-feeding. Acta Paediatr Scand 1987, 76:727-732.
29. McIntosh ID: Hospital effects of maternity early discharge. Med Care 1984, 22:611-619.
30. Kotagal UR, Atherton HD, Lippert CA, Gragg EJ, Donovan EF, Perlstein PH: Average newborn hospital stays can be reduced without increasing resource use following discharge [abstract]. Pediatr Res 1995, 37:109A.
31. American Academy of Pediatrics, Committee on Genetics: New issues in newborn screening for phenylketonuria and congenital hypothyroidism. Pediatrics 1982, 69:104-106.
32. McCabe ERB, McCabe L, Mosher GA, Allan RJ, Berman JL: Newborn screening for phenylketonuria: predictive validity as a function of age. Pediatrics 1983, 72:390-398.
33. Holtzman C, Slazyk WE, Cordero JF, Hannon WH: Descriptive epidemiology of missed cases of phenylketonuria and congenital hypothyroidism. Pediatrics 1986, 78:553-558.
34. Sinai LN, Kim SC, Casey R, Pinto-Martin JA: Phenylketonuria screening: effect of early newborn discharge. Pediatrics 1995, 96:605-608.
35. Arnopp JJ, Lorey FW, Currier RJ, Eastman JW, Velazquez KB, Morales DR, Cunningham GC: Results of screening for phenylketonurla using a lower cutoff value in early collected specimens. Screening 1995, 3:193-199.
36. Medical Research Council Steering Committee for MRC/DHHS: Routine neonatal screening for phenylketonuria in the United Kingdom 1964-78. BMJ 1981, 282:1680.
37. Doherty LB, Rohr FJ, Levy HL: Detection of phenylketonuria in the very early newborn blood specimen. Pediatrics 1991, 87:240-244.
38. American Academy of Pediatrics, Committee on Fetus and Newborn: Criteria for early infant discharge and follow-up evaluation. Pediatrics 1980, 65:86.
39. American Academy of Pediatrics Committee on Fetus and Newborn, American College of Obstetricians and Gynecologists Committee on Obstetrics: Guidelines for Perinatal Care, edn 3. Elk Grove Village, IL: American Academy of Pediatrics; 1992:108-109.
40. Maisels MJ, Kring E: Early discharge from the newborn nursery: effect on scheduling of follow-up visits by pediatricians [abstract]. Pediatr Res 1995, 37:221A.
41. American Academy of Pediatrics, Committee on Fetus and Newborn: Hospital stay for healthy term newborns. Pediatrics 1995, 96:788-790. This article provides minimum criteria to be met before newborn discharge, and states that it is unlikely that these could be fulfilled in less than 48 hours. Short hospital stay could be accomplished for some infants, but may not be appropriate for every mother and infant. The discharge decision should not be made arbitrarily by third-party payors, but by the physician caring for the infant.
42. Cottrell DG, Pittala LJ, Hey DJ: One day maternity care: a pediatric viewpoint J Am Osteopath Assoc 1983, 83:216-221.