Aggiornamento
La dimissione del neonato fisiologico.
Dalla revisione del problema a un possibile protocollo
HOSPITAL DISCHARGE OF HEALTHY NEWBORNS
RICCARDO DAVANZO, CRISTINA BRONDELLO, ROBERTO CERCHIO
Neonatologia e Terapia Intensiva Neonatale, IRCCS “Burlo Garofolo”, Trieste
Novembre 2006 - pagg. 562 -569
Abstract
In the last decades worldwide, the length of hospital stay for newborns and their mothers after childbirth has dramatically shortened mainly due to economical reasons. This choice may imply some risks for the newborn. The present article highlights the importance of a careful paediatric assessment in determining the adequate time of each newborn’s discharge. Health workers should use a checklist to cover possible problems the newborn may encounter and should discuss some of them with parents at the time of hospital discharge. Guidelines suggested by the AAP are discussed and integrated with the recent literature.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Braveman P, Egeter S, Pearly M, Marchi K,
Miller C. Early discharge of newborns and
mothers: a critical review of the literature. Pediatrics
1995;96:716-26.
2. Centers for Disease Control. Trends in length of stady for hospital deliveries: United States, 1970-1992. MMWR Morb Mortal Wkly Rep 1995;44(17):335-7.
3. Bradley W. Newborns’ and Mothers’ Health Protection Act of 1996. Pub L No. 104-204.
4. Paludetto R. La dimissione precoce: luci ed ombre. Congresso Nazionale SIP 2004, Sessione plenaria di Neonatologia.
5. Biasini GC, Bianchi D, Fellini D. La dimissione precoce consente un risparmio di risorse? Quaderni acp 1999;6:10.
6. Baronciani D, Bellù R, Zanini R. I tre paradossi della dimissione precoce. Medico e Bambino 1999;18(3):181-3.
7. Brown S, Small R, Faber B, Krastley A, Davis P. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database of Systematic reviews 2002(3); CD002958.
8. Friedman MA, Spitzer AR. Discharge criteria for the term newborn. Pediatr Clin North Am 2004;51:599-618
9. Gentile R, Stevenson G, Dooley T, Franklin D, Kawabori I, Pearlman A. Pulsed Doppler echocardiographic determination of time of ductal closure in normal newborn infants. J Pediatr 1981;98(3):443-8.
10. Division of Family Health. Thermal control of the newborn: a practical guide. Geneva: WHO, 1993.
11. Arthur PG, Smith M, Hartmann PE. Milk lactose, citrate, and glucose as markers of lactogenesis in normal and diabetic women. J Pediatr Gastroenterol Nutr 1989;9(4):488-96.
12. AAP & ACOG. Committee on Obstetric Practice. Guidelines for perinatal care, 5th ed. 2002.
13. La Gamba G, Rapisardi G. Dimissione appropriata del neonato sano. Medico e Bambino 1999;18(9):574-8.
14. Marchetti F, La Gamba G. La dimissione precoce del neonato (Editoriale). Medico e Bambino 2002;21(10);636-7.
15. AAP, Committee on Foetus and Newborn. Hospital Stay for Healthy Term Newborns. Paediatrics 2004;113:1434-6.
16. ACP, SIN, FIMP, sIPPS, SIMP, SEMP, SIGO, AOGOI, ANDRIA, SIPPO, FNCO, ANCOPD, SOI, IPASVI. Raccomandazioni per l’Assistenza alla madre in puerperio e al neonato. Medico e Bambino 2000;19(1):35-43.
17. Marolla L. Il neonato dimesso precocemente. Medico e Bambino 2002;21(10):674-7.
18. Kiely M, Drum MA, Kessel W. Early discharge. Risks, benefits, and who decides. Clin Perinatol 1998;25(3):539-53.
19. Ferrando A. Dimissione precoce del neonato (Lettera). Medico e Bambino 1997;16(1): 15-6.
20. Lambert EC, Canent RV, Hohn AR. Congenital cardiac anomalies in the newborn. A review of condition causing death or severe distress in the first month of life. Pediatrics 1966;37:343-51.
21. Reich JD, Miller S, Brogdon B, et al. The use of pulse oximetry to detect congenital heart disease. J Pediatr 2003;142(3):268-72.
22. Bakr AF, Habib HS. Combining pulse oximetry and clinical examination in screening for congenital heart disease. Pediatr Cardiol 2005;26(6);832-5.
23. Maisels MJ, Kring E. Length of Stay, Jaundice, and Hospital Readmission. Pediatrics 1998;101(6):995-8.
24. Maisels MJ, Newman TB. Kernicterus in otherwise healthy, breast-fed term newborns. Pediatrics 1995;96(4):730-3.
25. Bromberger P, Lawrence JM, Braun D, Saunders B, Contreras R, Petitti DB. The influence of intrapartum antibiotics on the clinical spectrum of early-onset group B streptococcal infection in term infants. Pediatrics 2000;106:244-50.
26. Roddey OF Jr, Martin ES, Swetenburg RL. Critical weight loss and malnutrition in breastfed infants. Am J Dis Child 1981;135:597-9.
27. Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 2003;112(3):607-19.
28. Lawrence RA. A 35-year-old woman experiencing difficulty with breastfeeding. JAMA 2001;285(1):73-80.
29. Livingstone VH, Willis CE, Abdel-Wareth LO, Thiessen P, Lockitch G. Neonatal hypernatremic dehydration associated with breastfeeding malnutrition: a retrospective survey. CMAJ 2000;162(5):647-52.
30. Roncoroni I, Morgando MP. Il pediatra e l’osservazione della poppata: un importante strumento di lavoro. Medico e Bambino 2004; 23(3):167-73.
31. AAP. Breastfeeding and the Use of Human Milk. Pediatrics 2005;115:496-506.
32. Neifert MR. Prevention of breastfeeding tragedies. Pediatr Clin North Am 2001;48(2): 273-97.
33. Oddie S, Richmond S, Coulthard M. Hypernatremic dehydration and breast feeding: a population study. Arch Dis Child 2001;85:318- 20.
34. Rivers RRA. Infants of drug addicted mothers. In: Rennie JM, Roberton NRC. Textbook of Neonatology 3rd ed, 1999:443-51.
35. Buchi KF. The drug-exposed infant in the well-baby nursery. Clin Perinatol 1998;25(2): 335-50.
36. Kemp JS, Unger B, Wilkins D, Psara RM, Ledbetter TL, Graham MA, et al. Unsafe sleep practices and an analysis of bedsharing among infants dying suddenly and unexpectedly: results of a four-year, population-based, death-scene investigation study of sudden infant death syndrome and related deaths. Pediatrics 2000;106(3):E41.
37. Carpenter RG, Irgens LM, Blair PS, et al. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet 2004; 363:185-91
38. Moon RY, Oden RP, Grady KC. Back to Sleep: an educational intervention with women, infants, and children program clients. Pediatrics 2004;113(3 Pt 1):542-7.
39. Howard AW. Automobile restraints for children: a review for clinicians. CMAJ 2002; 167(7):769-73.
40. Ramchandani P, Stein A, Evans J, O’Connor TG - ALSPAC study team. Paternal depression in the postnatal period and child development: a prospective population study. Lancet 2005;365:2201-5.
41. Bernazzani O, Marks MN, Bifulco A, Siddle K, Asten P, Conroy S. Assessing psychosocial risk in pregnant/postpartum women using the contextual assessment of maternity experience (CAME)-recent life adversity, social support and maternal feelings. Soc Psychiatr Epidemiol 2005;40(6):497-508.
42. Apollonio MG, Barbiero C, Bascussi S, et al. Supporto precoce ai genitori. È necessario? Serve? Medico e Bambino 2005;24(9):589-98.
43. Elkan R, Hendrick D, Hewitt M, et al. The effectiveness of domiciliary health visiting: a systematic review of international studies and a selective review of the British literature. Health Technology Assessment 2000;4(13):1- 339.
44. Chapman J, Siegel E, Cross A. Home visitors and child health: analysis of selected programs. Pediatrics 1990;85(6):1059-68.
45. Barlow J, Pearson J. Group-based parenttraining programmes for improving emotional and behavioural adjustment in 0-3 years old children. Cochrane Database Syst Rev 2003 (1):CD003680.
46. Barlow J, Coren E. Parent-training programmes for improving maternal psychosocial health. Cochrane Database Syst Rev 2004 (1):CD002020.
47. Coren E, Barlow J, Stewart-Brown S. The effectiveness of individual and group-based parenting programmes in improving maternal psychosocial health. J Adolesc 2003;26(1):79- 103.
48. Irons M. Screening for metabolic disorders: how are we doing? Ped Clin North Am 1993;40(5):1073-85.
49. AAP, Committee on Genetics. Newborn screening Fact Sheets. Pediatrics 1996;98(3): 473-501.
50. Sinai LN, Kim SC, Casey R, Pinto-Martin JA. Phenylketonuria screening: effect of early newborn discharge. Pediatrics 1995;96:605-8.
51. Lock M, Ray JG. Higher neonatal morbidity after routine early hospital discharge: Are we sending newborns home too early? CMAJ 1999;161(3):249-53.
52. Oddie SJ, Hammal D, Richmond S, Parker L. Early discharge and readmission to hospital in the first month of life in the Northern Region of the UK during 1998: a case cohort study. Arch Dis Child 2005;90:119-24.
53. Escobar GJ, Greene JD, Hulac P, et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gestations. Arch Dis Child 2005;90:125-31.
54. Edmonson MB, Stoddard JJ, Owens LM. Hospital readmission with feeding related problems after early postpartum discharge of normal newborn. JAMA 1997;278(4):299-303.
55. Hall RT, Simon S, Smith MT. Readmission of breastfed infants in the first 2 weeks of life. J Perinatol 2000;20(7):432-7.
56. Lichtenstein B, Brumfield C, Cliver S, Chapman V, Lenze D, Davis V. Giving birth, going home: influences on when low-income women leave hospital. Health (London) 2004; 8(1):81-100.
57. AAP, Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114(1):297-316.
58. Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and nearterm newborns. Pediatrics 1999;103(1):6-14.
59. Newman TB, Liljestrand P, Escobar GJ. Combining clinical risk factors with serum bilirubin levels to predict hyperbilirubinemia in newborns. Arch Pediatr Adolesc Med 2005; 159:113-9.
2. Centers for Disease Control. Trends in length of stady for hospital deliveries: United States, 1970-1992. MMWR Morb Mortal Wkly Rep 1995;44(17):335-7.
3. Bradley W. Newborns’ and Mothers’ Health Protection Act of 1996. Pub L No. 104-204.
4. Paludetto R. La dimissione precoce: luci ed ombre. Congresso Nazionale SIP 2004, Sessione plenaria di Neonatologia.
5. Biasini GC, Bianchi D, Fellini D. La dimissione precoce consente un risparmio di risorse? Quaderni acp 1999;6:10.
6. Baronciani D, Bellù R, Zanini R. I tre paradossi della dimissione precoce. Medico e Bambino 1999;18(3):181-3.
7. Brown S, Small R, Faber B, Krastley A, Davis P. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database of Systematic reviews 2002(3); CD002958.
8. Friedman MA, Spitzer AR. Discharge criteria for the term newborn. Pediatr Clin North Am 2004;51:599-618
9. Gentile R, Stevenson G, Dooley T, Franklin D, Kawabori I, Pearlman A. Pulsed Doppler echocardiographic determination of time of ductal closure in normal newborn infants. J Pediatr 1981;98(3):443-8.
10. Division of Family Health. Thermal control of the newborn: a practical guide. Geneva: WHO, 1993.
11. Arthur PG, Smith M, Hartmann PE. Milk lactose, citrate, and glucose as markers of lactogenesis in normal and diabetic women. J Pediatr Gastroenterol Nutr 1989;9(4):488-96.
12. AAP & ACOG. Committee on Obstetric Practice. Guidelines for perinatal care, 5th ed. 2002.
13. La Gamba G, Rapisardi G. Dimissione appropriata del neonato sano. Medico e Bambino 1999;18(9):574-8.
14. Marchetti F, La Gamba G. La dimissione precoce del neonato (Editoriale). Medico e Bambino 2002;21(10);636-7.
15. AAP, Committee on Foetus and Newborn. Hospital Stay for Healthy Term Newborns. Paediatrics 2004;113:1434-6.
16. ACP, SIN, FIMP, sIPPS, SIMP, SEMP, SIGO, AOGOI, ANDRIA, SIPPO, FNCO, ANCOPD, SOI, IPASVI. Raccomandazioni per l’Assistenza alla madre in puerperio e al neonato. Medico e Bambino 2000;19(1):35-43.
17. Marolla L. Il neonato dimesso precocemente. Medico e Bambino 2002;21(10):674-7.
18. Kiely M, Drum MA, Kessel W. Early discharge. Risks, benefits, and who decides. Clin Perinatol 1998;25(3):539-53.
19. Ferrando A. Dimissione precoce del neonato (Lettera). Medico e Bambino 1997;16(1): 15-6.
20. Lambert EC, Canent RV, Hohn AR. Congenital cardiac anomalies in the newborn. A review of condition causing death or severe distress in the first month of life. Pediatrics 1966;37:343-51.
21. Reich JD, Miller S, Brogdon B, et al. The use of pulse oximetry to detect congenital heart disease. J Pediatr 2003;142(3):268-72.
22. Bakr AF, Habib HS. Combining pulse oximetry and clinical examination in screening for congenital heart disease. Pediatr Cardiol 2005;26(6);832-5.
23. Maisels MJ, Kring E. Length of Stay, Jaundice, and Hospital Readmission. Pediatrics 1998;101(6):995-8.
24. Maisels MJ, Newman TB. Kernicterus in otherwise healthy, breast-fed term newborns. Pediatrics 1995;96(4):730-3.
25. Bromberger P, Lawrence JM, Braun D, Saunders B, Contreras R, Petitti DB. The influence of intrapartum antibiotics on the clinical spectrum of early-onset group B streptococcal infection in term infants. Pediatrics 2000;106:244-50.
26. Roddey OF Jr, Martin ES, Swetenburg RL. Critical weight loss and malnutrition in breastfed infants. Am J Dis Child 1981;135:597-9.
27. Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 2003;112(3):607-19.
28. Lawrence RA. A 35-year-old woman experiencing difficulty with breastfeeding. JAMA 2001;285(1):73-80.
29. Livingstone VH, Willis CE, Abdel-Wareth LO, Thiessen P, Lockitch G. Neonatal hypernatremic dehydration associated with breastfeeding malnutrition: a retrospective survey. CMAJ 2000;162(5):647-52.
30. Roncoroni I, Morgando MP. Il pediatra e l’osservazione della poppata: un importante strumento di lavoro. Medico e Bambino 2004; 23(3):167-73.
31. AAP. Breastfeeding and the Use of Human Milk. Pediatrics 2005;115:496-506.
32. Neifert MR. Prevention of breastfeeding tragedies. Pediatr Clin North Am 2001;48(2): 273-97.
33. Oddie S, Richmond S, Coulthard M. Hypernatremic dehydration and breast feeding: a population study. Arch Dis Child 2001;85:318- 20.
34. Rivers RRA. Infants of drug addicted mothers. In: Rennie JM, Roberton NRC. Textbook of Neonatology 3rd ed, 1999:443-51.
35. Buchi KF. The drug-exposed infant in the well-baby nursery. Clin Perinatol 1998;25(2): 335-50.
36. Kemp JS, Unger B, Wilkins D, Psara RM, Ledbetter TL, Graham MA, et al. Unsafe sleep practices and an analysis of bedsharing among infants dying suddenly and unexpectedly: results of a four-year, population-based, death-scene investigation study of sudden infant death syndrome and related deaths. Pediatrics 2000;106(3):E41.
37. Carpenter RG, Irgens LM, Blair PS, et al. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet 2004; 363:185-91
38. Moon RY, Oden RP, Grady KC. Back to Sleep: an educational intervention with women, infants, and children program clients. Pediatrics 2004;113(3 Pt 1):542-7.
39. Howard AW. Automobile restraints for children: a review for clinicians. CMAJ 2002; 167(7):769-73.
40. Ramchandani P, Stein A, Evans J, O’Connor TG - ALSPAC study team. Paternal depression in the postnatal period and child development: a prospective population study. Lancet 2005;365:2201-5.
41. Bernazzani O, Marks MN, Bifulco A, Siddle K, Asten P, Conroy S. Assessing psychosocial risk in pregnant/postpartum women using the contextual assessment of maternity experience (CAME)-recent life adversity, social support and maternal feelings. Soc Psychiatr Epidemiol 2005;40(6):497-508.
42. Apollonio MG, Barbiero C, Bascussi S, et al. Supporto precoce ai genitori. È necessario? Serve? Medico e Bambino 2005;24(9):589-98.
43. Elkan R, Hendrick D, Hewitt M, et al. The effectiveness of domiciliary health visiting: a systematic review of international studies and a selective review of the British literature. Health Technology Assessment 2000;4(13):1- 339.
44. Chapman J, Siegel E, Cross A. Home visitors and child health: analysis of selected programs. Pediatrics 1990;85(6):1059-68.
45. Barlow J, Pearson J. Group-based parenttraining programmes for improving emotional and behavioural adjustment in 0-3 years old children. Cochrane Database Syst Rev 2003 (1):CD003680.
46. Barlow J, Coren E. Parent-training programmes for improving maternal psychosocial health. Cochrane Database Syst Rev 2004 (1):CD002020.
47. Coren E, Barlow J, Stewart-Brown S. The effectiveness of individual and group-based parenting programmes in improving maternal psychosocial health. J Adolesc 2003;26(1):79- 103.
48. Irons M. Screening for metabolic disorders: how are we doing? Ped Clin North Am 1993;40(5):1073-85.
49. AAP, Committee on Genetics. Newborn screening Fact Sheets. Pediatrics 1996;98(3): 473-501.
50. Sinai LN, Kim SC, Casey R, Pinto-Martin JA. Phenylketonuria screening: effect of early newborn discharge. Pediatrics 1995;96:605-8.
51. Lock M, Ray JG. Higher neonatal morbidity after routine early hospital discharge: Are we sending newborns home too early? CMAJ 1999;161(3):249-53.
52. Oddie SJ, Hammal D, Richmond S, Parker L. Early discharge and readmission to hospital in the first month of life in the Northern Region of the UK during 1998: a case cohort study. Arch Dis Child 2005;90:119-24.
53. Escobar GJ, Greene JD, Hulac P, et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gestations. Arch Dis Child 2005;90:125-31.
54. Edmonson MB, Stoddard JJ, Owens LM. Hospital readmission with feeding related problems after early postpartum discharge of normal newborn. JAMA 1997;278(4):299-303.
55. Hall RT, Simon S, Smith MT. Readmission of breastfed infants in the first 2 weeks of life. J Perinatol 2000;20(7):432-7.
56. Lichtenstein B, Brumfield C, Cliver S, Chapman V, Lenze D, Davis V. Giving birth, going home: influences on when low-income women leave hospital. Health (London) 2004; 8(1):81-100.
57. AAP, Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114(1):297-316.
58. Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and nearterm newborns. Pediatrics 1999;103(1):6-14.
59. Newman TB, Liljestrand P, Escobar GJ. Combining clinical risk factors with serum bilirubin levels to predict hyperbilirubinemia in newborns. Arch Pediatr Adolesc Med 2005; 159:113-9.
Corrispondenza: davanzor@burlo.trieste.it