This situation could increase overall cost and worsen quality of care. World J Pediatr 2014;10(3):211–8. Lavagno C, Camozzi P, Renzi S, et al. However, mothers should feel supported in their own feeding choices. However, identification of some problems may require longer observation. Under CLD the decision for discharge is made and documented by the senior medical clinician (e.g. Flaherman VJ, Schaefer EW, Kuzniewicz MW, Li SX, Walsh EM, Paul IM. Pediatrics 2002;110(1 Pt 1):53–60. Canada’s Family-Centred Maternity and Newborn Care: National Guidelines [1] outline the goals of care during this time: For this statement, the term ‘family’ is intended to reflect the diversity of families in Canada, including those with single parents and same-sex partners and adoptive families. During the same period, LOS following Caesarean section (CS) birth decreased from 5.0 days to 3.4 days. The Rourke Baby Record provides guidance on specific items to include with the physical assessment during the first week of life [29]. The authors concluded that same-day discharge is safe for patients with suspected or biopsy-proven MH after uncomplicated ambulatory surgery. Gastrointestinal obstruction and hyperbilirubinemia requiring treatment are not always clinically apparent within 24 h of birth [14][15]. There is no conclusive evidence to demonstrate whether a shorter hospital LOS increases risk to infant health or to establish the ideal LOS for healthy term newborns. Paediatr Child Health 2014;19(4):201–12. Verify here. Sword WA, Watt S, Krueger PD et al. Current Opin Pediatrics 2004;14(4):361–5. The Agency for Healthcare Research and Quality offers information and tools for clinicians and patients to make the hospital discharge process safer and to prevent avoidable readmissions. Newborn screening in Canada status report. Shakib J, Buchi K, Smith E, Korgenski K, Young PC. 1. After a stay in hospital, it should be a relief for patients to return home but a report from the Parliamentary and Health Service Ombudsman (2016) describes extreme cases in which patients and their families have experienced serious problems while waiting for, or after, discharge. Pediatrics 2015;135(1):e16–23. Godel JC; Canadian Paediatric Society, First Nations, Inuit and Metis Health Committee. The relative risk (RR) of newborn readmission following early discharge was 1.25 (95% confidence interval (CI) 0.97 to 1.61). This review emphasized the importance of appropriate metabolic screening, breastfeeding education, and postdischarge follow-up. Many mother–infant dyads are ready to go home 24 h after birth. Acta Paediatr 2008;97(5):579–83. J Hum Lact 2016;32(1):67–74. That same year, a comprehensive review by Quebec’s Conseil d’evaluation des technologies de la sante found there was no conclusive link between early discharge (≤48 h after vaginal birth and <96 h after CS birth) and neonatal mortality, neonatal complications or duration of breastfeeding [7]. J Pediatr 2012;161(2):234–9.e1. 1. Clin Pediatr (Phila) 2000;39(10):581–90. Montreal: Technologies CETS 97-6 RE. Rennie JM. Risk factors for hyperbilirubinemia in breastfed term neonates. However, there does not appear to be significant health benefit to re-examining well, low-risk infants before discharge when the initial routine examination was performed in the first 24 h to 72 h postbirth [24][25]. At least 95% of healthy term newborn infants pass their first stool by 24 h of age. Three studies have suggested that hospital readmission and emergency room visits are reduced when newborns are seen within a few days of discharge [54]–[56], whereas one found that assessments completed within 3 days of discharge have little impact on these outcomes [57]. Physical examination (including head circumference and length) by a health care provider is complete and documented, with no additional in-hospital or ongoing observations or treatments needed. Pediatrics 2015;135(3):469–74. Because the risk of hemorrhagic disease of the newborn is higher when vitamin K is not given intra-muscularly, it is crucial that follow-up doses are given. Most cardiorespiratory issues related to transition present within the first 6 h to 12 h [10]. Paediatr Child Health 2007;12(Suppl B):1B–12B. Rourke L, Leduc D. Rourke Baby Record: (Accessed May 7, 2018). Passage of urine and meconium should be noted. Conseil d’evaluation des technologies de la sante. Examining the normal neonate. J Perinatol 2010;30(Suppl):S6–15. Pediatrics 2004;114(1):297–316. ABSTRACT Reed, H. (2003) Criteria for the safe dis-charge of patients from the recovery room. Arch Dis Child 2006;91(3):238–40. Not all diseases are detected reliably when the screening blood spot is collected before 24 h of age and, in these cases, a follow-up sample must be collected within the first week postbirth. Information should be supplemented by talking with the mother and reviewing any concerns that she may have. The definition of early discharge ranged from 6 h to 72 h after childbirth but was shorter than the standard LOS for the hospitals included in each trial. Pediatrics 2001;108(3):719–27. Patel H, Feldman M; Canadian Paediatric Society, Community Paediatrics Committee. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation (Clinical practice guideline). 4. Earlier discharge can facilitate family integration, enhance parent–infant bonding, allow the mother to recover in a quieter home environment with family support, and decrease exposure to nosocomial infection. Table 102–4516, Live births and fetal deaths (stillbirths), by place of birth (hospital and non-hospital), Canada, provinces and territories: (Accessed May 7, 2018). Rev Esc Enferm USP 2011;45(3):758–63. The facts that bilirubin levels peak and weight loss reaches a nadir between days 3 and 5 [13][58] support an initial postdischarge assessment within 24 h to 72 h following an early discharge. The specific length of stay for newborn infants depends on the health of their mother, infant health and stability, the mother’s ability to care for her infant, support at home, and access to follow-up care. Screening for issues of concern, behavior, and/or medical problems that may impact a safe discharge can be identified at Bravo P, Uribe C, Contreras A. <> Desmond MM, Rudolph AJ, Phitaksphraiwan P. The transitional care nursery. A study of safety and risk factors. When weight loss approaches or exceeds 10% of birth weight, adequacy of feeding must be assessed before discharge. Several studies … Evidence based medicine: What it is and what it isn’t. Vitamin K and ophthalmia neonatorum prophylaxis have been administered in accordance with provincial/territorial guidelines. 7. METHODS: A stratified random sample of charts from newborns who were … A 2011 review of 15 studies drew similar conclusions to previous reviews—evidence was insufficient to support or reject early discharge [9]. These include but are not limited to: Legible and complete antenatal records must be readily available for review by the infant’s HCP. Parents must receive a written record summarizing their infant’s health information, any health issues encountered during the hospital stay, bilirubin and other laboratory results, and a follow-up plan for care. Decide how will you get home from hospital. Various tools are used to assess risks for stress, depression, and parenting problems and to monitor child development. The mother must also be provided with additional education and support. Guidelines need to be in place to help nurses in the During the hospital stay, health care providers (HCPs) should evaluate the infant’s physical health, identify early problems, assist with establishment of feeding, observe parent–infant interaction, and identify psychosocial stressors. Joint Statement on Safe Sleep: Preventing Sudden Infant Deaths in Canada, 2011. (Accessed May 7, 2018). A CPS statement provides guidance for POS screening [48]. A randomized comparison of home and clinic follow-up visits after early postpartum hospital discharge. Most newborn care guidelines recommend a postdischarge assessment by an HCP within the first week of life. Privacy Policy, Search position statements and practice points, Most current statements and practice points, Education Program for Immunization Competencies, International Meeting on Indigenous Child Health, NRP Research Grant and Emerging Investigator Award, How much? endobj : H39-527/2000E. Jefferies A; Canadian Paediatric Society, Fetus and Newborn Committee. Discharge of late preterm infants (340/7 to 366/7 weeks’ GA) ( and preterm infants <34 weeks’ GA ( is reviewed in two other Canadian Paediatric Society (CPS) statements [3][4]. Successful cardiorespiratory adaptation to extrauterine life, with normal, stable heart and respiratory rates. In some Canadian provinces and territories, hepatitis B vaccine is routinely given to all infants. 1007: (Accessed May 7, 2018). No one model appears to be more effective than others for improving breastfeeding outcomes, decreasing hospital readmission rates, or decreasing visits to emergency rooms or doctors’ offices [60]-[64]. Reference chart for relative weight change to detect hypernatraemic dehydration. Paul IM, Beiler JS, Schaefer EW et al. Many trials are not randomized, co-interventions—including postdischarge support—vary, and definitions of early discharge are inconsistent, ranging from <24 h to <48 h. Health care practices and funding may differ from those in Canada. Public Health Agency of Canada, Health Canada, Canadian Paediatric Society, Canadian Foundation for the Study of Infant Deaths, Canadian Institute of Health. An abnormal transition period, characterized by problems such as respiratory distress, hypoglycemia, temperature instability, lethargy and septic risk factors, increases the likelihood of problems in the first few days of life that require prolonging hospitalization or readmission [14]. The CPS, Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association now recommend that pulse oximetry screening (POS) for congenital heart disease be routinely performed in healthy term newborns. Forsythe PL, Maher R, Kirchick C, Bieda A. 26 May 2016. Criteria for the safe discharge of patients from the recovery room AUTHOR Helen Reed, RGN, BA, is staff nurse, Freeman Hospital, Newcastle upon Tyne. Early term delivery and health care utilization in the first year of life. Pediatrics 2015;135(5):948–53. Senior Consultant, Medical Fellow, Visiting Medical Officer). Physical findings for infants examined during the first 6 h of life may vary as these infants transition [22], and functional heart murmurs are heard more frequently when the infant is examined early [23]. Document first published: 19 March 2020 Page updated: 3 September 2020 Topic: Coronavirus, COVID-19 Publication type: Guidance. 3 0 obj Ideally, the examination should be performed in the mother’s room, with parents present, to minimize separation of mother and baby, facilitate parental questions, and provide confidentiality. The objective should be to achieve a safe and early discharge. Public Health Agency of Canada. Wong KK, Fournier A, Fruitman DS et al. Infant temperature is stable: in an open cot, with the newborn appropriately dressed. Making an appropriate decision for discharge can be complex because perception of readiness may differ between HCPs and mothers [39]. Adequacy of breastfeeding can be assessed by direct observation of the feeding position, latch and swallow. ” Only a doctor can authorize a patient ʼ s release from the hospital, but the actual process of discharge planning can be completed by a social worker, nurse, case manager, or other person. Pan-Canadian inventory of public health early child home visiting: Key facts and glossary. The overall safety record of modern ambulatory anesthesia is impressive , with major morbidity and mortality being extremely rare . Each infant must have an appropriate discharge plan, including identification of the infant’s primary health care provider and assessment by a health care provider 24 h to 72 h after discharge. Delayed diagnosis of imperforate anus: An unacceptable morbidity. Physicians tend to focus on infant clinical and physical factors, although maternal age, social risk factors, fatigue, and stress are important considerations [40]. without being infectious) Important components of parental education include: Parents of infants with risk factors for sepsis should understand the signs of infection and when to seek medical help [18]. A Covid-19 patient meeting the following criteria can be considered for discharge: afebrile without use of fever-reducing agents for at least 48 hours improving hypoxia and respiratory symptoms (particularly shortness of breath, since up to 29% of patients may have persistent cough for up to 3 weeks) Yonemoto N, Dowswell T, Nagai S, Mori R. Schedules for home visits in the early postpartum period. Nurs Womens Health 2014;18(4):333–9. Antigonish, NS: St. Francis Xavier University, December 2009. (Accessed May 8, 2018). Parents have demonstrated that they can position the seat and secure the infant appropriately. Weight loss in excess of 10% increases the risk of hyperbilirubinemia [31][32] and hypernatremia [33][34]. Lomax A, editor. Ottawa: Minister of Public Works and Government Services Canada; 2000. Mothers are more likely to perceive themselves as unready to take their newborn home compared with HCPs, particularly if they are first-time parents, did not receive adequate prenatal care, gave birth during nonroutine hours and did not receive adequate in-hospital education [41]. Arch Pediatr Adolesc Med 2012;166(3):263–70. An abnormality is detected in approximately 8% to 10% of newborns [24][25]. Discharge plans can help prevent future readmissions, and they should make your move from the hospital to your home or another facility as safe as possible. The HCP should assess and note parent–infant interaction, ask how the family is coping and inquire about any psychosocial or socio-economic stressors. When the mother is breastfeeding, arrangements for monitoring the infant’s weight and postdischarge lactation support must be made. Available by request at (Accessed May 7, 2018). Nursing Times; 99: 38, 22–24. The purpose of this statement is to provide guidance for HCPs and ensure safe discharge of healthy term infants who are ≥37 weeks’ gestational age (GA) at birth. A shorter postpartum LOS highlights that low-risk birth is an event defined by ‘wellness’ rather than illness. This document has been produced upon request of an EU/EEA Member State. A search of MEDLINE that included the search terms ‘hospital stay’, ‘discharge’, ‘readmission’, ‘well-baby visit’, and ‘newborn’ was undertaken and updated in May 2016. Paediatr Child Health 2004;9(10):723–9. Pulse oximetry screening for critical congenital heart disease (CCHD) is now recommended for term infants before discharge. O’Donnell HC, Colman G, Trachtman RA, Velazco N, Racine AD. 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