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CPS Statements 2018-2020 > Facilitating Discharge From The Hospital Of The Healthy Term Infant > Flashcards

Facilitating Discharge From The Hospital Of The Healthy Term Infant Flashcards

1
Q

What are the goals during the postnatal period

A
  1. Promote physical wellbeing of the mother and infant
  2. Support the relationship among the mother, infant and family members
  3. Facilitate development of infant feeding skills
  4. Foster development of parenting skills
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2
Q

What are the goals of in-hospital care for the infant

A
  1. Infant’s physical health
  2. Identify early problems
  3. Establish feeds
  4. Observe parent-infant interactions
  5. Identify psychosocial stressors
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3
Q

What is considered a term infant

A

> 37 weeks at birth

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4
Q

What is the average LOS in hospital for healthy term infants

A

SVD 2.0 days

C/S 3.4 days

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5
Q

What are the benefits to shorter LOS

A
  1. Facilitates family integration
  2. Enhance parent-infant bonding
  3. Allow mother to recover at home, with family support
  4. Decrease exposure to nosocomial infections
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6
Q

What are cons to shorter LOS for the healthy term infant

A
  1. Decrease parental education
  2. Delayed identification of postnatal problems
  3. Readmissions for postnatal problems like jaundice, dehydration
  4. Shorter duration of BF
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7
Q

What does the evidence say about LOS?

A

4 systematic reviews

  • data does not support or refute early discharge
  • RR for readmission following discharge was 1.25
  • emphasized importance for metabolic screening, BF education, follow up
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8
Q

How long should healthy term infants stay in hospital?

A

Long enough to identify major problems

~24h as 50-95% of problems require higher level care present in that time frame

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9
Q

When do the following present in healthy term infants?

  1. Cardio-Resp issues
  2. GI obstruction
  3. Hyperbilirubinemia
  4. Non-syndromic CHD
A
  1. 6-12h
    2 and 3. Sometimes >24h
  2. 30% present in 1st 3 days of life
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10
Q

What are risk factors that need to be identified for safe discharge

A

Maternal:

  • health, MH, relevant family history
  • psychosocial stress, SES stress, IPV
  • maternal medications, substance use
  • abN prenatal screening, U/S
  • maternal positive serologies for HBV, HIV, syphilis, rubella
  • GBS status, IAP received

Infant

  • birthweight
  • risk for hypoglycemia
  • birth injury
  • APGAR stores
  • need for resuscitation
  • Risk factors for early onset neonatal jaundice
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11
Q

When do newborns need to be examined? What should it include?

A

24-72h

Full examination, including confirming GA, all measurements

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12
Q

How often rate abnormalities detected in newborns?

A

8-10%

**most commonly missed: cleft palate, imperforate anus

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13
Q

What factors increase the risk for prolonged hospitalization or readmissions?

A 
Respiratory distress
Hypoglycemia 
Temperature instability
Lethargy
Septic risk factors 
Weight loss >10% - risk hyperbilirubinemia and hypernatremia
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14
Q

What percent of infants stool in first 24 hours of life?

A

95%

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15
Q

What parental factors increase the risk for re-admission for healthy term infants? (3)

A

First-time parent
Younger GA
Low household income

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16
Q

What family factors are important to identify before discharging healthy term infant?

A
  1. Low parental education
  2. Low SES
  3. Young maternal age
  4. Language barriers
  5. Inadequate housing
  6. Inadequate prenatal care
  7. Parental use of illicit substance or alcohol
  8. Depression
  9. Isolation
  10. Lack of family support
  11. Unstable parental relationships
17
Q

What factors make parents feel unready to take their infant home?

A
  1. First time parents
  2. Inadequate prenatal care
  3. Birth outside routine hours
  4. Inadequate in-hospital education
18
Q

What are important components of parental education for safe discharge home?

A
  1. Infant feeding, including BF
  2. Normal newborn behaviour and care
  3. Recognition of early signs of illness, including jaundice, dehydration
  4. Infant safety - car seat use, safe sleep, SIDS prevention
  5. Infection control measures
  6. Importance of smoke free environment
  7. If sepsis risk factors - signs of infection and when to seek help
19
Q

What newborn screening is done in Canada?

A
  1. Metabolic screening(if before 24h needs to be repeated within 1 week)
  2. Hyperbilirubinemia - at discharge or within 72h (whichever comes first)
  3. CCHD screening between 24-36h
  4. Vaccinations as needed - HBV, BCG
  5. Hearing screen
20
Q

When should post-discharge follow up occur

A

Within 24-72h if early discharge as bilirubin and weight loss peaks between day 3-5

21
Q

What factors determine maternal readiness for discharge

A
  1. Mother provides routine infant care in a safe and confident manner
  2. Mother demonstrates knowledge of recognizing infant illness and when to seek help
  3. Psychosocial and environmental risk factors have been assessed and there is a follow up plan
22
Q

What determines infant health readiness for discharge

A
  1. Physical exam done
  2. Birth measurements recorded
  3. Stable temperature, RR, HR
  4. Passed urine and meconium
  5. Weight loss <10%, or close to 10% with good follow up
  6. Minimum 2 successful feeds
  7. Antenatal and perinatal RF reviewed
  8. Maternal serology reviewed
  9. If circumcision done - no bleeding at site
23
Q

What infant treatments need to be done before discharge

A

Vitamin K
Ophthalmia neonatorum ppx
Immunisation as needed

24
Q

What parental education needs to be done?

A 
Routine infant care
Infant safety and injury prevention
(Includes having approved car seat, and parents can put infant in safely and appropriately)
Feeding 
When to seek medical help
Care of circumcision site
25
Q

What follow up should be arranged?

A 
Follow up within 24-72h after discharge 
Community HCP has been identified
Lactation support if needed 
Other investigations, referrals and appointments organized
Community supports offered

CPS Statements 2018-2020 (16 decks)

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