Organizzazione sanitaria
I tre paradossi della dimissione precoce
THE PARADOXES OF EARLY DISCHARGE
DANTE BARONCIANI, ROBERTO BELLÙ, RINALDO ZANINI
Unità Operativa di Patologia Neonatale, Azienda Ospedale di Lecco
Marzo 1999 - pagg. 181 -183
Abstract
The evidence on the health consequences of early newborn discharge are reviewed. Most
of the studies on early discharge are aimed at showing that early discharge is safe and
that no serious negative side effects are produced, rather than showing any benefit. In fact,
marginal benefits from early discharge were shown only on breastfeeding. In many settings
early discharge is accompanied by home visiting and follow up programs to reduce the risk
of negative heakth events but the ultimate effect of this policy is to provide more services
to low risk families. Finally, little attention has been paied to the consequences of early discharge
on the familiar context rather than only on newborn health. For example, studies
do not address the problem of maternal depression which could be affected by discharge
policies. The author reports data from his own maternity service showing a high prevalence
of health and social problems among the mothers soon after discharge from maternity. In
conclusion, the debate on early discharge is diverting the attention from the real problems
linked with the whole birth experience and the role that health services can play to promote
a better start.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
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10. Margolis LH, KotelchickM, Hsing Yi Chang: Factors associated with early maternal postpartum discharge from the hospital. Arch Pediatr Adolesc Med 151, 466-72, 1997.
11. Murray L, Stein A: The effects of postnatal depression on the infant. Bailliere Clin Obst Gynec 3, 921-33, 1989.
12. Parisi VM, Meyer BA: To stay or not to stay? That is the question. N Engl J Med 333, 1635-7, 1995.
13. Ray Kl, Hodnett ED: Caregiver support for postpartum depression (Cochrane Review). In: The Cochrane Library, Issue 4, 1998; Oxford; Update Software.
14. Romito P: Unhappiness after childbirth. In: Chalmers I, Enkin MW, Keirse MJNC (editors). Effective care in pregnancy and childbirth. New York: Oxford University Press, 1433-66, 1989.
15. Romito P: Postpartum depression and the experience of motherhood. Acta Obstet Gynecol Scand 69; Suppl, 154, 7-19, 1990.
16. Waldenstrom U, Sudelin C, Lindmark G: Early and late discharge after hospital birth. Breastfeeding. Acta Paediatr Scand 76, 727- 32, 1987.
17. Young D: Early discharge: whose decision, whose responsibility? Birth 23,61-71, 1995.
2. Braveman P. Egerter S, Pearl M, Marchi K, Miller C: Early discharge of newborns and mothers: a critical review of the literature. Pediatrics 96, 716-26, 1995.
3. Britton JR, Britton HL, Beebe SA: Early discharge of the term newborn: a continued dilemma. Pediatrics 94, 291-5, 1994.
4. Brown G, Harris T: Social origin of depression. Tavistock, London 1978.
5. Carty EM, Bradley CF: A randomized, controllod evaluation of early postpartum hospital discharge. Birth 17, 199-204, 1990.
6. Fergusson DM, Horwood LJ, Thorpe K and the ALSPAC Study Team: Changes in depression during and following pregnancy. Pediatrics and Perin Epidemiol 10, 279-93, 1996.
7. Kessel W, Kiely M, Nora AH, Sumaya CV: Early discharge: in the end, it is judgment. Pediatrics 96, 739-42, 1995.
8. Maisels MJ, Newman TB: Kernicterus in otherwise healthy, breastfeed term newborns. Pediatrics 96, 730-733, 1995.
9. Margolis LH: A critical review of studies of newborn discharge timing. Clinical Pediatrics 626-34, 1995.
10. Margolis LH, KotelchickM, Hsing Yi Chang: Factors associated with early maternal postpartum discharge from the hospital. Arch Pediatr Adolesc Med 151, 466-72, 1997.
11. Murray L, Stein A: The effects of postnatal depression on the infant. Bailliere Clin Obst Gynec 3, 921-33, 1989.
12. Parisi VM, Meyer BA: To stay or not to stay? That is the question. N Engl J Med 333, 1635-7, 1995.
13. Ray Kl, Hodnett ED: Caregiver support for postpartum depression (Cochrane Review). In: The Cochrane Library, Issue 4, 1998; Oxford; Update Software.
14. Romito P: Unhappiness after childbirth. In: Chalmers I, Enkin MW, Keirse MJNC (editors). Effective care in pregnancy and childbirth. New York: Oxford University Press, 1433-66, 1989.
15. Romito P: Postpartum depression and the experience of motherhood. Acta Obstet Gynecol Scand 69; Suppl, 154, 7-19, 1990.
16. Waldenstrom U, Sudelin C, Lindmark G: Early and late discharge after hospital birth. Breastfeeding. Acta Paediatr Scand 76, 727- 32, 1987.
17. Young D: Early discharge: whose decision, whose responsibility? Birth 23,61-71, 1995.