Facilitating discharge from hospital of the healthy term infant

Question 1

pros of shortening hosp stay?

Answer 1

• family integration
• parent-baby bonding
• mom can recover at home
• decrease exposure to nosocomial infection

Question 2

cons to shortening hosp stay

Answer 2

decreased time for parental education, increased re-admission rate for jaundice, dehydration, shorter duration of breastfeeding

Question 3

Safe discharge depends on what RFs? give 8

Answer 3

Maternal medical and mental health concerns, positive family history
Psychosocial and/or socio-economic stressors, domestic violence
Maternal medications, smoking, alcohol, or substance use
Abnormal prenatal screening and ultrasound findings
Birth weight
Maternal hepatitis B surface antigen, syphilis, HIV, or rubella status
Maternal blood group and antibodies
Risk factors for infection, including maternal Group B streptococcal colonization status or intrapartum antibiotic prophylaxis [18][19]
Abnormal glucose homeostasis [20]
Developmental dysplasia of the hip [21]
Birth injury
Apgar score, need for stabilization at birth, and/or low umbilical cord pH
Risk factors for early-onset neonatal jaundice

Question 4

need to repeat baby’s PE if done within __ hours of life

Answer 4

6

Question 5

2 things often missed on physical exam?

Answer 5

Cleft palate and imperforate anus OFTEN MISSED

Question 6

3 maternal issues placing child at risk

Answer 6

low educational level, poor SES, young age, language barriers, inadequate housing, inadequate prenatal care, use of drugs/EtOH, depression, isolation, lack of family support, unstable parental relationships

Question 7

increased readmission rate associated with what?

Answer 7

first time parent, younger GA, low household income

Question 8

you are discharging new mom. 5 things to tell her re: new baby?

Answer 8

• review infant feeding adn importance of BF’ing
• recognition of early signs of illness
• infant safety, including car seat
• keep smoke free envrionemtn!
• care of circ site
• infection control measures

Question 9

screens to do before discharge? one that can be done at 72 h? one to do or arrange?

Answer 9

• NBS, pulse oximetry
• hyperbili at 72 h
• do or arrange hearing screen

Question 10

3 things re: mom readiness?

Answer 10

• can provide routine care, including feeding, well
• can recognize when baby is sick
• psychosocial and evnrionemtnal risk factors assessed (with follow up plan)

Question 11

5 things to make sure of before discharge re: health of baby

Answer 11

• phys exam
• measurements BW, HC, legnth done
• stable vital signs (temp, HR,RR)
• passed urine
• passed mec
• wt loss <10% (if near 10, need plan)
• minimum 2 good feeds
• mom’s serology reviewed
• assess circ site for bleeding
• assess antenatal/perinatal RFs (like sepsis)

Question 12

Treatment to give baby? (1-3)

Answer 12

• vit k
• +/- hep b
• +/- ppx for opthalmia neonatorum

Question 13

3 things to make sure arranged for follow up?

Answer 13

Infant’s community health care provider has been identified and recorded in chart
Follow-up visit scheduled for 24 h to 72 h after hospital discharge
Lactation support, if needed
Other investigations, referrals and appointments organized, as required
Community supportive resources have been offered

Question 14

for follow-up at 24-72 hours after dsicharge, check what 5 things?

Answer 14

Weight loss
o   Jaundice
o   Hydration
o   General health
o   Feeding
o   Congenital malformation
o   Family interaction
o   Assess for stressors
o   Anticipatory guidance: safety, feeding, Vit D, routine infant care

Question 15

parents should be given what at discharge?

Answer 15

Parents must receive a written record summarizing their infant’s health information