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Costa S, Coppola M, Fattore S, Tana M, Gassino L, Catalano P, Pastorino R, Vento G. Early Discharge of Newborns Born to Mothers with COVID-19: A Possible Safe Strategy. Am J Perinatol 2024; 41:e1116-e1119. [PMID: 36693387 DOI: 10.1055/s-0042-1760429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE In this study, we evaluated the safety of early discharge (ED) of newborns born to coronavirus disease 2019 (COVID-19)-positive mothers. STUDY DESIGN All ED newborns from the postpartum wards of the Fondazione Policlinico Gemelli between January 1, 2022, and February 28, 2022, were retrospectively analyzed. Newborns from mothers with COVID-19 and those from uninfected mothers were considered. The primary outcome was to evaluate whether the rate of the composite outcome, which was the percentage of rehospitalization/access in emergency room (RH/ER) within the first week from discharge, differed between neonates born to mother with COVID-19 (COVID-19 group) and those born to uninfected mothers (no COVID-19 group). The secondary outcomes were to assess the quality of feeding and number of outpatient visits in the follow-up clinic between the two cohorts of patients. RESULTS One hundred and thirty-four newborns in the no COVID-19 group and 26 in the COVID-19 group were analyzed. The rate of RH/ER in the no COVID-19 group was of 6 over 134 newborns (0.045, 95% confidence image [CI]: 0.017-0.095), while in COVID-19 group, it was of 2 over 26 newborns (0.077), which does not differ from the expected rate (1.17 over 26 newborns, 0.045, 95% CI: 0.017-0.095). CONCLUSION ED for newborns from mothers with COVID-19 could be an actionable safe strategy. KEY POINTS · We evaluated the feasibility of early discharge (ED) of mothers with COVID-19 and their newborns.. · Rate of rehospitalization between newborns from uninfected mothers and infected ones was comparable.. · ED could be an actionable practice for newborns from mothers with COVID-19..
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Affiliation(s)
- Simonetta Costa
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Maria Coppola
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Simona Fattore
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Milena Tana
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Lisa Gassino
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Paola Catalano
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Roberta Pastorino
- Section of Hygiene, Department of Woman and Child Health and Public Health-Public Health Area, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Department of Life Sciences and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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Early postpartum discharge before 48 h: An exhaustive review. J Gynecol Obstet Hum Reprod 2022; 51:102458. [DOI: 10.1016/j.jogoh.2022.102458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/06/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022]
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Koreska M, Petersen M, Andersen BL, Brødsgaard A. Supporting families on their journey towards a normal everyday life - facilitating partnership in an early discharge program for families with premature infants. J SPEC PEDIATR NURS 2020; 25:e12274. [PMID: 31576656 DOI: 10.1111/jspn.12274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE Several Danish neonatal intensive care units (NICUs) offer the possibility of an early discharge program (EDP) for families with premature infants, when the infant reaches the gestational age ≥ 34 weeks and a weight ≥ 1,500 g. The purpose of this study is to explore how the partnership with these families can be facilitated by the nurse based on the principles of the framework of family centered care (FCC). DESIGN AND METHODS The study was conducted as an ethnographic inquiry inspired by Spradley and based on participant observation of 12 contacts between nurse and family, one informal and three formal interviews with nurses in the EDP-unit of a Danish NICU. RESULTS This study illustrates how EDP-nurses facilitate a partnership with the families enrolled in EDP by using a range of complex strategies to adjust their care to the family's changing needs, while acknowledging the family's way of being. The partnership typically develops in three phases: "Settling in EDP," "Thriving in EDP," and "Leaving the EDP nest." The EDP-nurses have a clear understanding of whether a partnership is well functioning or challenging and they play a unique role by facilitating a partnership that supports the family on the journey towards a normal everyday life. PRACTICE IMPLICATIONS The knowledge unraveled in this study may prove helpful for training future EDP-nurses in the neonatal field of FCC, when improving the quality of an existing EDP or developing a new EDP based on the principles of FCC.
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Affiliation(s)
- Mai Koreska
- Unit of Neonatology, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Capital Region of Denmark, Denmark
| | - Mette Petersen
- Unit of Neonatology, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Capital Region of Denmark, Denmark
| | - Bente Lund Andersen
- Unit of Neonatology, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Capital Region of Denmark, Denmark
| | - Anne Brødsgaard
- Unit of Neonatology, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Capital Region of Denmark, Denmark.,Section for Nursing, Department of Public Health, University of Aarhus, Denmark
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Hardy G, Colas JA, Weiss D, Millar D, Forster A, Walker M, Corsi DJ. Effect of an innovative community-based care model, the Monarch Centre, on postpartum length of stay: an interrupted time-series study. CMAJ Open 2018; 6:E261-E268. [PMID: 30012645 PMCID: PMC6182112 DOI: 10.9778/cmajo.20180033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Reduction in postpartum length of stay has been advocated within a context of reducing health care system costs and maintaining quality of care. We assessed trends in postpartum length of stay for vaginal and cesarean deliveries at an academic hospital, The Ottawa Hospital, before and after the implementation in 2014 of a novel community-based postpartum outpatient clinic, the Monarch Centre. METHODS The Monarch Centre model of postpartum care consists of prebooked appointments at the postpartum clinic, scheduled within 48 hours of hospital discharge. Clients receive maternal assessment including mood screening and care, neonatal care, laboratory testing including infant total serum bilirubin level, and breast-feeding assessment and support. Family physicians, lactation consultants and registered nurses are available for consultation at the appointment, and there is coordination with institutional care, community partners and primary care providers. We used interrupted time-series regression models to assess trends in postpartum length of stay at The Ottawa Hospital between January 2012 and December 2016. RESULTS There were 16 023 deliveries with 16 515 babies born over the study period. The mean postpartum length of stay was 46 hours (66 h for cesarean deliveries and 37 h for vaginal deliveries). Eighteen months after implementation of the centre, the average length of stay following a cesarean birth had decreased by 20 hours, a relative reduction of 27% (95% confidence interval [CI] 9.5 to 30.4); for vaginal deliveries, length of stay was reduced by 6 hours, a relative reduction of 18% (95% CI 5.2 to 31.1), and by 12 hours among typical cases (relative reduction 28%, 95% CI 19.2 to 36.6). There was a decrease in the proportion of women with a length of stay exceeding 48 hours after centre implementation. An increase in the rate of 30-day readmission from 1.1% to 1.9% was observed among babies. INTERPRETATION A strong association was found between implementation of a community-based multidisciplinary postpartum clinic and declines in postpartum length of stay. This alternative model of postpartum care is safe, has the potential for reducing provider costs and should be considered for further implementation at provincial and national levels.
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Affiliation(s)
- Ghislain Hardy
- Department of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont
| | - Jo Ann Colas
- Department of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont
| | - Deborah Weiss
- Department of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont
| | - David Millar
- Department of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont
| | - Alan Forster
- Department of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont
| | - Mark Walker
- Department of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont
| | - Daniel J Corsi
- Department of Obstetrics and Gynecology (Hardy), London Hospital, London, Ont.; Quality, Performance and Population Health (Colas, Forster), The Ottawa Hospital; BORN (Better Outcomes Registry and Network) Ontario (Weiss), Children's Hospital of Eastern Ontario and School of Epidemiology and Public Health, University of Ottawa; Monarch Maternal and Newborn Health (Millar); Ottawa Hospital Research Institute, OMNI (Obstetrics & Maternal Newborn Investigations) Research Group (Walker, Corsi); Department of Obstetrics and Gynecology (Walker), Faculty of Medicine, and School of Epidemiology and Public Health (Corsi), University of Ottawa, Ottawa, Ont.
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Pertile R, Pavanello L, Soffiati M, Manica L, Piffer S. Length of stay for childbirth in Trentino (North-East of Italy): the impact of maternal characteristics and organizational features of the maternity unit on the probability of early discharge of healthy, term infants. Eur J Pediatr 2018; 177:155-159. [PMID: 29116396 DOI: 10.1007/s00431-017-3035-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED Early discharge (ED) of healthy term infants has become a common practice due to current social and economic needs. The primary objective of the present study was to evaluate trends in early discharge of healthy term neonates (≥ 37 gestational weeks) by delivery method (cesarean and vaginal) in maternity units in the Province of Trento. The secondary objective was to identify the socio-demographic characteristics (including the area of residence and distance from the designated hospital) and clinical characteristics of mothers whose infants were discharged early. This retrospective study reviewed records of live births from 2006 to 2016, for a total of 45, 314 healthy term infants. The trend for ED grew significantly during the period 2006-2016, for both cesarean and vaginal deliveries. The multiple logistic regression analysis shows how the determinants of ED are maternal age, birth order, citizenship of mother, maternal smoking, maternal employment status, and the number of births at the hospital on the day of birth. CONCLUSION The post-partum length of stay should be adjusted based on the characteristics and needs of the mother-infant dyad, identifying the criteria for safe discharge. In Trento, various procedures and programs are becoming more uniform today with the intention to provide family assistance service. What is Known: • Admission for childbirth is one of the primary causes of hospitalization in industrialized countries. • The length of stay for childbirth has been steadily declining in recent decades, with the aim of reducing costs while also demedicalizing pregnancy. What is New: • A higher rate of early discharge (ED) was recorded for neonates of women having foreign citizenship, < 30 years, pluriparous, smoked during pregnancy, housewife, and, if emplyed, entrepreneurs, self-employed professionals or managers. • ED was more common when the new mother gave birth on a day in which there was a higher number of births at the hospital, indicating overcrowding in the maternity unit.
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Affiliation(s)
- Riccardo Pertile
- Clinical and Evaluative Epidemiology Department, Trento Health Service, Viale Verona, 38123, Trento, Italy.
| | - Lucia Pavanello
- Neonatal Unit, Trento Health Service, Largo Medaglie d'Oro 9, 38122, Trento, Italy
| | - Massimo Soffiati
- Neonatal Unit, Trento Health Service, Largo Medaglie d'Oro 9, 38122, Trento, Italy
| | - Laura Manica
- Maternal and child health clinic of Rovereto, Trento Health Service, Via San Giovanni Bosco 10, 38068, Rovereto, TN, Italy
| | - Silvano Piffer
- Clinical and Evaluative Epidemiology Department, Trento Health Service, Viale Verona, 38123, Trento, Italy
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Benahmed N, San Miguel L, Devos C, Fairon N, Christiaens W. Vaginal delivery: how does early hospital discharge affect mother and child outcomes? A systematic literature review. BMC Pregnancy Childbirth 2017; 17:289. [PMID: 28877667 PMCID: PMC5588709 DOI: 10.1186/s12884-017-1465-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 08/22/2017] [Indexed: 01/08/2023] Open
Affiliation(s)
- Nadia Benahmed
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Lorena San Miguel
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Carl Devos
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Nicolas Fairon
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Wendy Christiaens
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
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Metcalfe A, Mathai M, Liu S, Leon JA, Joseph KS. Proportion of neonatal readmission attributed to length of stay for childbirth: a population-based cohort study. BMJ Open 2016; 6:e012007. [PMID: 27630070 PMCID: PMC5030571 DOI: 10.1136/bmjopen-2016-012007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Most literature on length of stay (LOS) for childbirth focuses on 'early' discharge as opposed to 'optimal' time of discharge and has conflicting results due to heterogeneous definitions of 'early' discharge and differing eligibility criteria for these programmes. We aimed to determine the LOS associated with the lowest neonatal readmission rate following childbirth by examining the incidence pattern of neonatal readmission for different LOS using the Kitagawa decomposition. DESIGN Retrospective cohort study using administrative hospitalisation data. SETTING Canada (excluding Quebec) from 2003 to 2010. PATIENTS Term, singleton live births without congenital anomalies. INTERVENTIONS LOS for childbirth. MAIN OUTCOME MEASURE Neonatal readmissions within 30 days of birth. RESULTS 1 875 322 live births were included. Neonatal LOS peaked at day 1 (47.3%) after vaginal birth and day 3 (49.3%) following caesarean section; 4.2% of infants were readmitted following vaginal birth and 2.2% after caesarean section. In 2008-2010, most readmissions occurred among infants discharged in the first 2 days (83.8%) following a vaginal birth and among infants discharged in the first 3 days (81.7%) following a caesarean birth. Readmissions increased from 4.1% in 2003-2005 to 4.6% in 2008-2010 among vaginal births and from 2.0% to 2.4% among caesarean births and occurred mostly due to changes in the day-specific readmission rates and not due to reductions in LOS. CONCLUSIONS Patterns of readmission suggest that readmission rates are lowest following a 1-2-day stay following a vaginal birth and a 2-4-day stay following a caesarean birth given the outpatient support in the community.
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Affiliation(s)
- Amy Metcalfe
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
| | - Matthews Mathai
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Shiliang Liu
- Maternal, Child and Youth Health, Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Juan Andres Leon
- Maternal, Child and Youth Health, Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - K S Joseph
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
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