Facilitating Discharge From The Hospital Of The Healthy Term Infant Flashcards
What are the goals during the postnatal period
- Promote physical wellbeing of the mother and infant
- Support the relationship among the mother, infant and family members
- Facilitate development of infant feeding skills
- Foster development of parenting skills
What are the goals of in-hospital care for the infant
- Infant’s physical health
- Identify early problems
- Establish feeds
- Observe parent-infant interactions
- Identify psychosocial stressors
What is considered a term infant
> 37 weeks at birth
What is the average LOS in hospital for healthy term infants
SVD 2.0 days
C/S 3.4 days
What are the benefits to shorter LOS
- Facilitates family integration
- Enhance parent-infant bonding
- Allow mother to recover at home, with family support
- Decrease exposure to nosocomial infections
What are cons to shorter LOS for the healthy term infant
- Decrease parental education
- Delayed identification of postnatal problems
- Readmissions for postnatal problems like jaundice, dehydration
- Shorter duration of BF
What does the evidence say about LOS?
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
How long should healthy term infants stay in hospital?
Long enough to identify major problems
~24h as 50-95% of problems require higher level care present in that time frame
When do the following present in healthy term infants?
- Cardio-Resp issues
- GI obstruction
- Hyperbilirubinemia
- Non-syndromic CHD
- 6-12h
2 and 3. Sometimes >24h - 30% present in 1st 3 days of life
What are risk factors that need to be identified for safe discharge
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
When do newborns need to be examined? What should it include?
24-72h
Full examination, including confirming GA, all measurements
How often rate abnormalities detected in newborns?
8-10%
**most commonly missed: cleft palate, imperforate anus
What factors increase the risk for prolonged hospitalization or readmissions?
Respiratory distress Hypoglycemia Temperature instability Lethargy Septic risk factors Weight loss >10% - risk hyperbilirubinemia and hypernatremia
What percent of infants stool in first 24 hours of life?
95%
What parental factors increase the risk for re-admission for healthy term infants? (3)
First-time parent
Younger GA
Low household income
What family factors are important to identify before discharging healthy term infant?
- Low parental education
- Low SES
- Young maternal age
- Language barriers
- Inadequate housing
- Inadequate prenatal care
- Parental use of illicit substance or alcohol
- Depression
- Isolation
- Lack of family support
- Unstable parental relationships
What factors make parents feel unready to take their infant home?
- First time parents
- Inadequate prenatal care
- Birth outside routine hours
- Inadequate in-hospital education
What are important components of parental education for safe discharge home?
- Infant feeding, including BF
- Normal newborn behaviour and care
- Recognition of early signs of illness, including jaundice, dehydration
- Infant safety - car seat use, safe sleep, SIDS prevention
- Infection control measures
- Importance of smoke free environment
- If sepsis risk factors - signs of infection and when to seek help
What newborn screening is done in Canada?
- Metabolic screening(if before 24h needs to be repeated within 1 week)
- Hyperbilirubinemia - at discharge or within 72h (whichever comes first)
- CCHD screening between 24-36h
- Vaccinations as needed - HBV, BCG
- Hearing screen
When should post-discharge follow up occur
Within 24-72h if early discharge as bilirubin and weight loss peaks between day 3-5
What factors determine maternal readiness for discharge
- Mother provides routine infant care in a safe and confident manner
- Mother demonstrates knowledge of recognizing infant illness and when to seek help
- Psychosocial and environmental risk factors have been assessed and there is a follow up plan
What determines infant health readiness for discharge
- Physical exam done
- Birth measurements recorded
- Stable temperature, RR, HR
- Passed urine and meconium
- Weight loss <10%, or close to 10% with good follow up
- Minimum 2 successful feeds
- Antenatal and perinatal RF reviewed
- Maternal serology reviewed
- If circumcision done - no bleeding at site
What infant treatments need to be done before discharge
Vitamin K
Ophthalmia neonatorum ppx
Immunisation as needed
What parental education needs to be done?
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
What follow up should be arranged?
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
