Early discharge after delivery. A study of safety and risk factors

The increased frequency of early discharge of newborns has led to questions of its safety. Most studies have looked at mortality and rehospitalization, not all missed diagnoses. The purpose of this study was to determine diagnoses in newborn infants that would have been missed if the infant had been discharged in <24 h. The design was a cohort study at Rabin Medical Center-Beilinson Campus (average monthly deliveries 1996 [250], 1997 [500]), a university-affiliated community hospital with all in-born term (> or = 37 weeks) infants born September through November 1996 and June 1997. The main outcome measures were medical diagnoses (except trivial physical descriptions) noted at discharge (generally at > or =48 h) exam, not noted on admission exam (<24 h). The results showed that 54 infants (5.1%) had diagnoses that were not detected before the infant was 24 h of age. The leading diagnosis was hyperbilirubinemia. Other potentially missed diagnoses included congenital heart disease (n = 10), morbidity of birth trauma (n = 9), metabolic disturbances (n = 2), hip dislocation (n = 1), suspected sepsis (n = 2), excessive weight loss (n = 2), polycythemia (n = 2), inguinal hernia (n = 1), and abducens paresis (n = 1). It is concluded that diagnoses can be missed by discharging infants in 24 h or less. These diagnoses have the potential for adverse sequela. Even if early discharge is felt to be cost effective, parents should be counseled that it is not risk free. Better mechanisms should be put in place for assuring the safety of such infants.

Single-room infant care: future trends in special care nursery planning and design

For the past several years, health care providers specializing in the treatment of neonates have been working steadily to improve the environment for premature and sick neonates in order to optimize outcomes. They have also begun to recognize that involving the family in every aspect of care not only has positive value for the family, but can improve outcomes for neonates as well. This article examines how the staff at one hospital closely utilized and married these two concepts, developmentally supportive care and family-centered care, to design a Level II special care nursery that embraces parents as partners in treatment. Each phase of design development is described, including space programming, schematic design, environmental design, and design development, as well as the successful use of a multidisciplinary team.

Breast-feeding policies and routines among Arizona hospitals and nursery staff: results and implications of a descriptive study

In 1988, Arizona's 61 hospitals providing obstetrical services were canvased with regard to hospital routines that favor either breast-feeding or bottle-feeding. Forty-five hospitals provided responses that were used in the survey. Practices favoring breast-feeding, which were reported by a majority of the hospitals (more than 50%), were demand feeding, staff assessment for "latch-on" (the action of nipple presentation and sucking initiation) and positioning, "rooming-in" (the practice of minimal mother-infant separation), and information about follow-up support services. Hospital practices suggested to promote bottle-feeding were the provision of pacifiers and supplemental water or glucose, issuance of formula packs at discharge, and a first feed of sterile water. A positive significant relationship was identified for policies advocating breast-feeding and the prevalence of breast-feeding encouragement from professional staff. Of 44 respondents, 41 indicated that their hospital's policies endorse breast-feeding as the ideal method of feeding healthy newborns. Hospital staff perceived that they encourage mothers to breast-feed and offer support to those who initiate breast-feeding. On the basis of this information, we conclude that dietetics practitioners should evaluate current breast-feeding practices and integrate policies supportive of breast-feeding into the health care system.

An intermediate care nursery at Christchurch Women's Hospital: the first year

Following the Sheldon report (UK 1971) the proportion of newborn infants admitted to neonatal units in England and Wales rose to 20% of live births. Admission policies in Christchurch have followed Sheldon's recommendations and by 1981, 37% of all infants born in Christchurch Women's Hospital were admitted to the neonatal unit. Admission criteria were reviewed in 1982 with the result that most infants with a birth weight greater than 2.5 kg are no longer admitted to the unit. In addition an intermediate nursery was opened to admit healthy but low birth weight (1.8 to 2.5 kg) infants together with their mothers. In 1983 only 9.7% of inborn infants were admitted to the neonatal unit. Data relating to the operation of the intermediate nursery are presented.

Assessing trends in perinatology

Hospital administrators must respond as the medical profession renews its efforts to reduce newborn mortality rates. Technological changes in the case of obstetric and newborn patients, pressures for the regionalization of service, and consumer demands for a more humane birth environment are factors the administrator must consider.