Discharge of late preterm newborn: appropriated, controlled…namely safe
A Coscia
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A Soldi
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C Perathoner
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L Occhi
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E Bertino
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References 1. EURO-PERISTAT Project with SCPE and EUROCAT: European Perinatal Health Report. The health and care of pregnant women and babies in Europe in 2010. 2013. 2. Tomashek KM, Shapiro-Mendoza CK, Weiss J, et al: Early discharge among late pre- term and term newborns and risk of neonatal morbidity. Semin Perinatol 2006
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30(2):61-68. 3. Engle WA, Tomashek KM, Wallman C
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Committee on Fetus and Newborn, American Academy of Pediatrics: Late-preterm infants: a population at risk.
Pediatrics 2007, 120(6):1390-1401. 4. Goyal NK
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Teeters A, Ammerman RT: Home Visiting and Outcomes of Preterm Infants: A Systematic Review.
Pediatrics 2013, 132:502-516
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SC Neonatology, University of Turin, AOA Citta della Salute e della Scienza
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Turin
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Italy
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From XX National Congress of the Italian Society of Neonatology
Rome, Italy. 9-11 October 2014
Late-preterm newborns accounted for 8.7% of all US
births in 2009, while in Italy, according to Euro-Peristat
Report 2010, rate of preterm live births between 32 and
36 weeks accounts for 6.4%: therefore late-preterm
incidence is around 5% [1]. In the literature is reported that
late preterm infants are at increased risk of neonatal
mortality and morbidity, including feeding problems,
hyperbilirubinemia, hypoglycemia, and respiratory
problems. So, in recent years, research has focused on
hospital care, with little known about the real needs of care
after discharge and in the home setting. However, its
known that early discharge places these infants at
greater risk of complications such as rehospitalizazion,
particularly in breastfed infants [2].
Therefore in this population its fundamental to plan an
appropriate discharge. What does appropriateness
mean? In health care the appropriateness has two
aspects: 1) the clinical appropriateness that refers to the
criteria of efficacy and safety; 2) the so-called
administrative appropriateness that indicates the extent of
provision of health according to the criterion of efficiency,
that is the best use of available resources, with respect to
the clinical case to be treated. Because the resources
available vary by context, administrative appropriateness
is a very dynamic concept.
In the discharge of late-preterm baby, clinical
appropriateness requires individualization and involvement of
family. Discharge criteria are substantially similar to
those of full-term [3] but include longer observation
times, more attention to the real understanding and
involvement of the family in the scheme of nutrition
and follow-up, and an increased need for planning
follow-up and integration with local services.
Although discharge criteria for late preterm infants are
quite precise, however there is a large inter-center
heterogeneity regarding the timing of discharge. Its clear
that the choices on the discharge of late preterm
newborns are strongly influenced by the organizational
context. It should be essential to have accurate
population-based surveillance data and organizational
data, as well as clinical ones. Only in this way it is
possible to evaluate the efficacy (and on which outcomes) of
programs of protected discharge, and their compatibility
with the available resources. For example, some studies
suggest that home visiting promotes improved
parentinfant interaction; however further studies are needed to
demonstrate whether such interventions in at-risk
populations may strengthen their impact and cost benefits [4].
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