Early perinatal hospital discharge: issues and concerns
Gespeichert in:
Format: | Buch |
---|---|
Sprache: | English |
Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1998
|
Schriftenreihe: | Clinics in perinatology
25,2 |
Schlagworte: | |
Online-Zugang: | Inhaltsverzeichnis |
Beschreibung: | XIV S., S. 257 - 527 Ill., graph. Darst. |
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EARLY PERINATAL HOSPITAL DISCHARGE
CONTENTS
Preface xiii
John R. Britton
The History of Policy and Practice Related to the Perinatal
Hospital Stay 257
Elizabeth H. Thilo, Susan F. Townsend,
and Gerald B. Merenstein
The issue of early newborn discharge has received widespread
attention in both the lay press and the medical literature over the
past few years, culminating in passage of Public Law 104 204,
Title VI: The Newborns' and Mothers' Health Protection Act of
1996. This article reviews the road to passage of this legislation,
including the historical trends and forces determining postpartum
length of stay in the United States, the evolution of guidelines as
put forth by official representative bodies such as the AAP, the
current status of state and federal legislation, and the relationship
between length of stay and follow up practices. The status of
newborn length of stay in other countries also is discussed.
The Transition to Extrauterine Life and Disorders
of Transition 271
John R. Britton
With shorter postnatal hospital stays, concern has arisen that
many infants may be discharged prior to completion of the transi¬
tion to extrauterine life, a time of dynamic physiologic change
when many neonatal problems may present. This article reviews
the physiology of the neonatal transition together with common
transitional disorders. Most disorders of transition present at typi¬
cal postnatal time periods, permitting their timely anticipation
CLINICS IN PERINATOLOGY VOLUME 25 • NUMBER 2 • JUNE 1998 V
and treatment. Moreover, many are associated with factors that
may further aid the clinician in defining those infants at highest
risk.
Jaundice in Full term and Near term Babies Who Leave the
Hospital Within 36 Hours: The Pediatrician's Nemesis 295
M. Jeffrey Maisels and Thomas B. Newman
There has been an increase in hyperbilirubinemia in the newborn
population and perhaps an increase in bilirubin encephalopathy
as well. The early discharge of newborns from the hospital has
made it necessary for pediatricians to reorient their thinking
about bilirubin levels in the first 24 48 hours of life and alter their
approach to follow up. The pediatrician must evaluate and follow
infants who have risk factors for the development of severe
hyperbilirubinemia, paying particular attention to the breast feed¬
ing, near term infant.
The Optimization of Breast feeding in the Perinatal Period 303
Marianne R. Neifert
Mounting scientific evidence documents the diverse health bene¬
fits of successful breast feeding for infants and mothers. The trend
toward earlier discharge of newborns, however, has been linked
with adverse outcomes in breast fed babies, including hyperna
tremic dehydration and hyperbilirubinemia. This article reviews
practical strategies for promoting the successful initiation of
breast feeding, beginning with effective prenatal education and a
screening breast exam to detect lactation risk factors. Supportive
hospital practices are discussed, including the Baby Friendly Hos¬
pital Initiative and correct breast feeding technique. The impor¬
tance of regular, effective removal of milk for continued milk
production is explained. The early follow up of infants after hos¬
pital discharge and the use of specific maternal and infant criteria
to assess the onset of breast feeding can readily identify mother
baby pairs who require timely intervention to improve breast¬
feeding outcome.
The Newborn at Risk for Serious Infections 327
Michael Radetsky
Early discharge of suitable newborns is rapidly becoming a hospi¬
tal standard. One concern is that truncated hospital observation
of the infant during the first days of life, even with home visits or
early clinical appointments, would allow early signs of a serious
infection to go unnoticed, which could lead to a missed chance
for early therapy and could imperil the child's favorable recovery.
An analysis of available data for early onset neonatal bacterial
sepsis and neonatal herpes virus infection shows that this new
practice should not unduly place newborns at risk of treatable
infections, however, so long as conventional risk factors are ap
Vi CONTENTS
preciated and reasonable, nationally sanctioned discharge criteria
are followed.
The Drug exposed Infant in the Well baby Nusery 335
Karen F. Buchi
Maternal substance use can have medical and developmental
consequences for the newborn. Many drug exposed infants are
admitted to term nurseries, and the newborn clinician who often
has never previously met the mother must gather both objective
and subjective information about problems in the pregnancy and
delivery that may indicate maternal substance abuse. This article
addresses the prevalence of maternal substance abuse in the
United States, the long term consequences of in utero drug expo¬
sure that makes early identification important, the identification
of a drug exposed neonate, and in hospital care and discharge
management of the drug exposed newborn.
Congenital Malformations Presenting During the
Neonatal Period 351
Julie Kessel and Robert M. Ward
Clinical signs that would lead to detection of several congenital
malformations may not be present at the time of examination
before early discharge. Transitional changes in the cardiovascular
system that begin at birth and continue for weeks will eventually
produce signs of several congenital cardiovascular malformations.
The four cardiac malformations most frequently diagnosed dur¬
ing the first week of life include transposition of the great arteries,
hypoplastic left heart syndrome, tetralogy of Fallot, and aortic
coarctation. Congenital disorders of the respiratory system and
gastrointestinal tract may be detected by careful attention to cry¬
ing, gastric volumes at birth, and patterns of feeding and stooling
after birth. Guidelines developed by the American Academy of
Pediatrics and the American College of Obstetrics and Gynecol
ogy for early discharge and follow up after early discharge will
help to detect congenital disorders that are relatively inapparent
during the first 1 2 days after birth.
Metabolic Screening 371
Elizabeth R. Brown
Mandated, universal metabolic screening has been an effective
tool for the early identification of infants with metabolic disor¬
ders, particularly those amenable to improved outcome with di¬
etary management or medication. Although the availability of
diagnosis long before symptoms occur may be useful to preclude
expensive diagnostic evaluation when the subtle early symptoms
begin and may allow for genetic counseling and testing in af¬
fected families, many concerns have been raised regarding the
psychologic impact of presymptomatic diagnosis of diseases that
CONTENTS Vii
are either fatal or for which no effective treatment is available.
Before mass screening is initiated, careful pilot studies need to be
done to evaluate sensitivity and specificity as well as the impact
of early identification on infant outcome.
Maternal Education During the Perinatal Period 389
Theresa S. Standing, Nahed El Sabagh, and Dorothy Brooten
The nature of perinatal education has been transformed, reflecting
the changes in health care and health care consumers. Because of
short maternity stays, the venue of most perinatal education,
especially postpartum education, has moved from hospitals to
other areas, including the home. In light of conflicting findings of
past research examining the effectiveness of prenatal education
as well as gaps in the literature, there is a need for research on
the content, methods, providers, and dose effect of perinatal
education.
Medical Conditions of the Puerperium 403
Michael W. Varner
The puerperium is a time of continued, dramatic pregnancy
associated adaptation. Although much less common than in the
early part of the century, maternal death can still occur from
common postpartum problems such as infection, hemorrhage,
and disease. This article reviews the physiologic and emotional
changes as well as the clinical management of common problems
in the puerperium.
The Perinatal Assessment of Psychosocial Risk 417
LaDawn J. Haglund and John R. Britton
Although evaluation of psychosocial risk factors prior to perinatal
hospital discharge has been advocated, the means for accomplish¬
ing such an evaluation are not well established. This article re¬
views several major psychosocial risk factors together with instru¬
ments that have been utilized to assess them during the perinatal
period. Formal constructs reviewed include anxiety, depression,
self concept, general attitudes, life events, stress, adaptation, so¬
cial support, marital and family functioning, and the home envi¬
ronment. Ongoing assessment of psychosocial status using formal
instruments during routine perinatal care may provide a more
complete picture of the psychosocial needs of the individual
mother and her family, allowing for more appropriate, timely
intervention and utilization of social and health care resources.
Perinatal Screening for Child Abuse and Neglect 453
Helen L. Britton
An increased awareness of the frequency and severity of child
abuse and neglect in our society has prompted consideration of
viii CONTENTS
the feasibility of perinatal screening and early intervention for
this problem. This article reviews the available information on
screening and early intervention for high risk parenting in the
perinatal period. The advantages, disadvantages, and cost effec¬
tiveness of screening and intervention for children and families
at risk for abuse and neglect are also discussed.
Assessing Parent Infant Interaction During the Perinatal
Period: Some Cautions 461
Michael E. Lamb
Pediatricians have recently been urged by professional groups to
pay increased attention to parental behavior when serving and
discharging newborns. These exhortations are well intended, but
they may reflect a misunderstanding of developmental processes
and foster a mistaken belief in the ease with which parenting
problems can be identified and remedied. This article describes
how early experiences affect children's development and then
contrasts this view with a popular perspective based on misappli¬
cation of the medical model to the conceptualization of behavioral
development.
Follow up of Newborns and Their Mothers After Early
Hospital Discharge 471
Susan A. Egerter, Paula A. Braveman, and Kristen S. Marchi
As postpartum hospital stays have become increasingly shorter,
more attention has been focused on the importance of routine
postdischarge follow up for newborns and mothers. Recent
guidelines and legislation, however, include few specifics on how
follow up services should be provided. Based on the authors'
review of the recent literature, it was concluded that the research
to date provides little useful information to guide follow up prac¬
tices under current conditions. Additional studies that focus on
postdischarge follow up, rather than on length of hospital stay,
are needed to provide the basis for more specific practice guide¬
lines.
Economic Aspects of the Perinatal Hospital Stay 483
Julie A. Gazmararian and Jeffrey P. Koplan
This article concentrates on the economics of the perinatal hospi¬
tal stay for normal vaginal and cesarean section deliveries. Pub¬
lished studies in the United States are reviewed under three
headings: inpatient costs for traditional stays, outpatient costs for
postpartum services, and costs for short stays with follow up
services. Despite the increasing attention on length of stay after
delivery, there has been minimal research examining the true
costs of an early discharge program and services compared with
longer hospital stays. Formal analysis of alternative strategies and
well designed clinical studies are needed before an optimal policy
for caring for mothers and infants can be identified.
CONTENTS ix
Early Discharge of Premature Infants: A Critical Analysis 499
Michele Raddish and T. Allen Merritt
Although significant advances in the medical management of
acutely ill preterm infants have resulted in unprecedented rates
of survival, issues surrounding the convalescent care, discharge
preparation, and readiness of parents or other caregivers have
been less well studied. Recent consensus statements provide a
degree of content validity; however, important areas of scientific
inquiry remain. Much is left to be understood about the patho
physiology, management, and outcomes of apnea, bradycardia,
and oxygen desaturation episodes continuing at term.
Index 521
Subscription Information Inside back cover
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series | Clinics in perinatology |
series2 | Clinics in perinatology |
spelling | Early perinatal hospital discharge issues and concerns John R. Britton, guest ed. Philadelphia [u.a.] Saunders 1998 XIV S., S. 257 - 527 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in perinatology 25,2 Maladies du nourrisson et du nouveau-né Perinatale geneeskunde gtt Verloskundige zorg gtt Ziekenhuisopname gtt Infants, Newborn, Diseases Newborn infants Diseases Newborn infants Medical care Patient Discharge Perinatal Care Stationäre Verweildauer (DE-588)4193968-2 gnd rswk-swf Krankenhaus (DE-588)4032786-3 gnd rswk-swf Neugeborenenkrankheit (DE-588)4041779-7 gnd rswk-swf Neugeborenes (DE-588)4041781-5 gnd rswk-swf Gesundheitsvorsorge (DE-588)4136584-7 gnd rswk-swf Therapieerfolg (DE-588)4126073-9 gnd rswk-swf Entlassung (DE-588)4152363-5 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content (DE-588)4135467-9 Ausstellungskatalog gnd-content Neugeborenes (DE-588)4041781-5 s Krankenhaus (DE-588)4032786-3 s Entlassung (DE-588)4152363-5 s DE-604 Neugeborenenkrankheit (DE-588)4041779-7 s Therapieerfolg (DE-588)4126073-9 s Stationäre Verweildauer (DE-588)4193968-2 s Gesundheitsvorsorge (DE-588)4136584-7 s Britton, John R. Sonstige oth Clinics in perinatology 25,2 (DE-604)BV000003382 25,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008131992&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
spellingShingle | Early perinatal hospital discharge issues and concerns Clinics in perinatology Maladies du nourrisson et du nouveau-né Perinatale geneeskunde gtt Verloskundige zorg gtt Ziekenhuisopname gtt Infants, Newborn, Diseases Newborn infants Diseases Newborn infants Medical care Patient Discharge Perinatal Care Stationäre Verweildauer (DE-588)4193968-2 gnd Krankenhaus (DE-588)4032786-3 gnd Neugeborenenkrankheit (DE-588)4041779-7 gnd Neugeborenes (DE-588)4041781-5 gnd Gesundheitsvorsorge (DE-588)4136584-7 gnd Therapieerfolg (DE-588)4126073-9 gnd Entlassung (DE-588)4152363-5 gnd |
subject_GND | (DE-588)4193968-2 (DE-588)4032786-3 (DE-588)4041779-7 (DE-588)4041781-5 (DE-588)4136584-7 (DE-588)4126073-9 (DE-588)4152363-5 (DE-588)4143413-4 (DE-588)4135467-9 |
title | Early perinatal hospital discharge issues and concerns |
title_auth | Early perinatal hospital discharge issues and concerns |
title_exact_search | Early perinatal hospital discharge issues and concerns |
title_full | Early perinatal hospital discharge issues and concerns John R. Britton, guest ed. |
title_fullStr | Early perinatal hospital discharge issues and concerns John R. Britton, guest ed. |
title_full_unstemmed | Early perinatal hospital discharge issues and concerns John R. Britton, guest ed. |
title_short | Early perinatal hospital discharge |
title_sort | early perinatal hospital discharge issues and concerns |
title_sub | issues and concerns |
topic | Maladies du nourrisson et du nouveau-né Perinatale geneeskunde gtt Verloskundige zorg gtt Ziekenhuisopname gtt Infants, Newborn, Diseases Newborn infants Diseases Newborn infants Medical care Patient Discharge Perinatal Care Stationäre Verweildauer (DE-588)4193968-2 gnd Krankenhaus (DE-588)4032786-3 gnd Neugeborenenkrankheit (DE-588)4041779-7 gnd Neugeborenes (DE-588)4041781-5 gnd Gesundheitsvorsorge (DE-588)4136584-7 gnd Therapieerfolg (DE-588)4126073-9 gnd Entlassung (DE-588)4152363-5 gnd |
topic_facet | Maladies du nourrisson et du nouveau-né Perinatale geneeskunde Verloskundige zorg Ziekenhuisopname Infants, Newborn, Diseases Newborn infants Diseases Newborn infants Medical care Patient Discharge Perinatal Care Stationäre Verweildauer Krankenhaus Neugeborenenkrankheit Neugeborenes Gesundheitsvorsorge Therapieerfolg Entlassung Aufsatzsammlung Ausstellungskatalog |
url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008131992&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
volume_link | (DE-604)BV000003382 |
work_keys_str_mv | AT brittonjohnr earlyperinatalhospitaldischargeissuesandconcerns |