Early postnatal hospital discharge: the consequences of reducing length of stay for women and newborns

Abstract

RESUMOO objetivo deste estudo é examinar a literatura e identificar os resultados mais relevantes da alta precoce pós-parto para as mulheres, recém-nascidos e o sistema de saúde. Uma estratégia de busca eletrônica foi projetada, incluindo as seguintes fontes: Web of Science, Scopus, ProQuest e PubMed/MEDLINE utilizando-se os seguintes termos: (precoce e alta hospitalar), ou (duração e permanência) e (pós-parto ou pós-natal) e (efeito de resultado ou * ou resultado). A análise de conteúdo foi utilizada para identificar e sintetizar os resultados e os métodos dos trabalhos de investigação. A evidência disponível não é suficiente para rejeitar ou apoiar a prática da alta precoce no pós-parto porque os estudos apresentaram resultados diferentes para as mulheres e os recém-nascidos. A necessidade de realizar estudos clínicos, de forma sistemática, é discutida. DESCRITORES ABSTRACTThe objective of this study is to examine the literature and identify most salient outcomes of early postnatal discharge for women, newborns and the health system. An electronic search strategy was designed including the following sources: Web of Science, Scopus, ProQuest and PubMed/ MEDLINE, using the following terms: (early AND discharge) OR (length AND stay) AND (postpartum OR postnatal) AND (effect* OR result OR outcome). Content analysis was used to identify and summarise the findings and methods of the research papers. The evidence available is not enough to either reject or support the practice of early postnatal discharge; different studies have reported different outcomes for women and newborns. The need of systematic clinical research is discussed. DESCRIPTORS RESUMENEste estudio objetivó examinar la literatura e identificar los resultados más relevantes del alta precoz postparto para las mujeres, recién nacidos y el sistema de salud. Una estrategia de búsqueda electrónica fue proyectada, incluyendo las siguientes fuentes: Web of Science, Scopus, ProQuest y PubMed/MEDLINE utilizando los siguientes términos: (precoz y alta hospitalaria), o (duración y permanencia) y (postparto o postnatal) y (efecto de resultado o resultado). El análisis de contenido fue utilizado para identificar y sintetizar los resultados y los métodos de los trabajos de investigación. La evidencia disponible no es suficiente para rechazar o apoyar la práctica del alta precoz en el postparto porque los estudios presentaron resultados diferentes para las mujeres y los recién nacidos. La necesidad de realizar estudios clínicos, de forma sistemática. es discutida DESCRIPTORES

Intervention among new parents followed up by an interview study exploring their experiences of telemedicine after early postnatal discharge

“…There is a continuing trend in many Western countries towards earlier discharge of patients from hospital after childbirth, and the average length of stay is 48-72 hours (Brown et al, 2002;Bravo et al, 2011;Sørensen, 2013).…”

“…Reviews (Brown et al, 2002;Bravo et al, 2011) have stated that it cannot be concluded that early postnatal discharge has consequences such as failed breast feeding, re-admission due to nutrition-related problems, and/or increased infant mortality and morbidity. It is difficult to draw precise conclusions due to between-study variations in antenatal preparation, definitions of early discharge and the types of followup offered.…”

Parental experiences of early postnatal discharge: A meta-synthesis

“…There have been considerable controversies over the consequences of early discharge from hospital after birth (Brown et al, 2002;Bravo et al, 2011). Sceptics point out potentially negative consequences such as delays in detecting and treating maternal and infant morbidity, problems related to breast feeding leading to early weaning, decreased maternal confidence, higher prevalence of maternal depression and increase in readmissions of mother and infant (Williams et al, 2003;Fink, 2011).…”

“…Results are possibly influenced by substantial variation in antenatal preparation, timing of early discharge and follow up (Bravo et al, 2011). A Cochrane review from 2002, concluded that early discharge of healthy mothers and term infants did not appear to have adverse effects on breast feeding or rate of maternal depression (Brown et al, 2002).…”

“Dad – a practical guy in the shadow”: Fathers’ experiences of their paternal role as a father during early discharge after birth and readmission of their newborns

“…Still the debate about early postnatal discharge has been ongoing. Sceptics point out potential negative consequences, 4 such as delays in detecting and treating maternal and newborn morbidity, breastfeeding problems leading to early weaning, decreased maternal confidence, higher prevalence of maternal depression and increase in readmissions of mother and newborn (2,4). In Denmark, readmissions of newborns due to nutritional problems have increased remarkable during the last 10 years where length of hospital stay has decreased (5).…”