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Early hospital discharge of the healthy term neonate: the Italian perspective
1Division of Neonatology, Department of Pediatrics, Federico II University, Naples, Italy.
Insights
Italian hospitals typically discharge healthy newborns after 72 hours, balancing safety with costs. Earlier discharge with follow-up care could improve outcomes and patient satisfaction for neonatal discharge.
Area of Science:
- Neonatal care
- Public health policy
- Pediatrics
Background:
- Establishing optimal hospital discharge timing for healthy neonates is crucial for balancing medicalization with early health risk surveillance.
- European guidelines for neonatal discharge timing are lacking, necessitating national policy assessments.
Purpose of the Study:
- To survey current neonatal discharge policies in Italian birth centers.
- To understand the practices regarding discharge timing and follow-up care for healthy term neonates.
Main Methods:
- A 13-item questionnaire was distributed to 136 Italian birth centers.
- Quantitative data were presented as mean ± range, and qualitative data as frequencies.
- Chi-squared tests were employed for statistical comparisons between variables.
Main Results:
- The average discharge age for vaginally delivered neonates was 72 hours; for those born via cesarean section, it was 97 hours.
- Most centers (95/98) would discharge healthy infants without hyperbilirubinemia risk factors at 72 hours with a total serum bilirubin (TSB) of 13 mg/dL, though 14.7% would not recheck TSB.
- For a healthy neonate with TSB=10 mg/dL at 45 hours, 67/98 centers would discharge, with 11.9% not rechecking TSB.
Conclusions:
- Most Italian hospitals discharge healthy, term neonates after spontaneous vaginal delivery (SVD) beyond 72 hours, aiming to prevent missed diagnoses like hyperbilirubinemia.
- Prolonged hospitalization increases maternal discomfort and healthcare costs.
- Implementing earlier discharge protocols with home visits or clinic follow-ups can mitigate risks, reduce costs, and enhance patient feedback.
Aim:
An appropriate timing of hospital discharge of the healthy, term neonate represents a balance between birth medicalization and surveillance of immediate health hazards. In the absence of European recommendations, the authors have conducted a broad national survey on the current policies of neonatal discharge.
Methods:
A 13-item questionnaire was sent to 136 Italian birth centers. Quantitative variables were expressed as mean+/-range. Qualitative variables were expressed as frequencies. chi squared test was used for variables comparison.
Results:
Mean age at discharge for a vaginally delivered neonate was 72 hours. Twelve percent of centres would not schedule a follow-up appointment. Neonates born after a cesarean section were discharged at a mean age of 97 hours. Almost all centres (95/98) would discharge an healthy infant without risk factors for hyperbilirubinemia with a total serum bilirubin (TSB) of 13 mg/dL at 72 hours but 14.7% of these centers would not recheck TSB. The same healthy neonate would be discharged at the age of 45 hours with a TSB=10 mg/dL in 67/98 centers and in 11.9% of cases would not be rechecked.
Conclusion:
Most Italian hospitals discharge healthy, term neonates born after spontaneous vaginal delivery (SVD) at over 72 hours of age. This policy should protect from missed diagnoses of clinical importance (e.g. hyperbilirubinemia). On the other hand, a prolonged hospitalization tends to increase maternal discomfort and medical costs. Implementing a protocol of home visits/clinic follow-up appointments after an earlier discharge may minimize health hazards and medical costs and optimizing the patient's feedback.
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