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Early discharge of term neonates: we can do it safely

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Italian Journal of Pediatrics

BioMed Central

71st Congress of the Italian Society of Pediatrics. Joint National Meeting SIP, SIMGePeD, Study Group on Pediatric Ultrasound, SUP Study Group on Hypertension

4-6 June 2015

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      Most cited references 10

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      Missed diagnosis of critical congenital heart disease.

      To evaluate the rate and the clinical and demographic characteristics of missed diagnosis of critical congenital heart disease (CCHD). Population-based retrospective study of 1989-2004 California statewide death registry data. California. The study cohort consisted of 898 infants who died of CCHD at 1 to 364 days of age who either did not undergo surgery or had an unknown surgery status. From all patients who met these initial criteria, we examined (1) whether autopsies were performed and autopsy results were used to establish the cause of death, (2) whether autopsies were performed but the results were not used to establish a cause of death, and (3) whether infants with hypoplastic left heart syndrome (HLHS) were potentially receiving comfort care. Missed and possibly late diagnosis of CCHD. Among 152 infants with a missed CCHD diagnosis, the median age at death was 13.5 days. More than 50% of patients with a missed CCHD diagnosis (n = 78) died at home or in the hospital emergency department. The most common diagnoses were HLHS and coarctation of aorta. There were an average of 10 patients with missed CCHD diagnoses and 20 patients with late diagnoses in California per year. The total annual number of patients with missed or late diagnoses decreased in 1989-1999 and remained unchanged in 2000-2004. Up to 30 infants per year died of a missed or possibly late diagnosis of CCHD in California. Most deaths due to a missed diagnosis were from HLHS and coarctation of the aorta. Because the median age at death was younger than 2 weeks, a careful cardiovascular evaluation for left heart obstructive CHD should be performed during the first postdischarge visit to a pediatrician's office at 3 to 5 days of age.
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        Increased neonatal readmission rate associated with decreased length of hospital stay at birth in Canada.

        To assess the potential impact of early post birth discharge in Canada. Neonatal readmission was examined, based on hospital discharge data from the Canadian Institute for Health Information, with a total of 2,144,205 infants from fiscal year 1989/90 to fiscal year 1996/97. Neonatal readmission rates increased from 27.3 per 1,000 in 1989/90 to 38.0 per 1,000 in 1996/97, while mean length of hospital stay at birth decreased from 4.2 days to 2.7 days during the same period. The increase in readmission rate was more evident for dehydration and jaundice. The provinces and territories with decreased length of hospital stay at birth usually had increased neonatal readmission rate and earlier age at readmission. Between 1994/95 and 1996/97, compared with Newfoundland, the risks for neonatal readmission for dehydration were 5.7 and 5.5, and for jaundice were 4.5 and 2.7, respectively, for Alberta and Ontario. Neonatal readmission rates for several conditions have increased substantially, associated with early post birth discharge policies adopted in Canada.
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          Kernicterus in otherwise healthy, breast-fed term newborns.

          To document the occurrence of classical kernicterus in full-term, otherwise healthy, breast-fed infants. We reviewed the files of 22 cases referred to us by attorneys throughout the United States during a period of 18 years, in which neonatal hyperbilirubinemia was alleged to be responsible for brain damage in apparently healthy, nonimmunized, full-term infants. To qualify for inclusion, these infants had to be born at 37 or more weeks' gestation, manifest the classic signs of acute bilirubin encephalopathy, and have the typical neurologic sequelae. Six infants, born between 1979 and 1991, met the criteria for inclusion. Their peak recorded bilirubin levels occurred 4 to 10 days after birth and ranged from 39.0 to 49.7 mg/dL. All had one or more exchange transfusions. One infant had an elevated reticulocyte count (9%) but no other evidence of hemolysis. The other infants had no evidence of hemolysis, and no cause was found for the hyperbilirubinemia (other than breast-feeding). Although very rare, classic kernicterus can occur in apparently healthy, full-term, breast-fed newborns who do not have hemolytic disease or any other discernible cause for their jaundice. Such extreme elevations of bilirubin are rare, and we do not know how often infants with similar serum bilirubin levels escape harm. We also have no reliable method for identifying these infants early in the neonatal period. Closer follow-up after birth and discharge from the hospital might have prevented some of these outcomes, but rare, sporadic cases of kernicterus might not be preventable unless we adopt an approach to follow-up and surveillance of the newborn that is significantly more rigorous than has been practiced. The feasibility, risks, costs, and benefits of this type of intervention need to be determined.
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            Author and article information

            Affiliations
            [1 ]Neonatology Unit, Gemelli University Hospital, 00168 Rome, Italy
            Conference
            Ital J Pediatr
            Ital J Pediatr
            Italian Journal of Pediatrics
            BioMed Central
            1824-7288
            2015
            30 September 2015
            : 41
            : Suppl 2
            : A42
            4707572
            1824-7288-41-S2-A42
            10.1186/1824-7288-41-S2-A42
            Copyright © 2015 Luciano.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            71st Congress of the Italian Society of Pediatrics. Joint National Meeting SIP, SIMGePeD, Study Group on Pediatric Ultrasound, SUP Study Group on Hypertension
            Rome, Italy
            4-6 June 2015
            Categories
            Meeting Abstract

            Pediatrics

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