Early hospital discharge of the healthy term neonate: the Italian perspective

• Published in: Minerva pediatrica Vol. 60; no. 3; p. 273
• Main Authors: Petrone, E, Mansi, G, Tosco, A, Capasso, L, Migliaro, F, Umbaldo, A, Romano, A, Paludetto, R, Raimondi, F
• Format: Journal Article
• Language: English
• Published: Italy 01.06.2008
• Subjects: Humans; Infant, Newborn; Italy; Length of Stay - statistics & numerical data; Patient Discharge; Surveys and Questionnaires; Italy
• ISSN: 0026-4946

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. 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. 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. 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.