Discharge against medical advice from Neonatal Intensive Care Unit: 10 years experience at a University Hospital

Abstract

Background:Discharging patients against medical advice is a problem of every age-group. However, because of their physiological vulnerability, the risk for the neonatal population is greater when discharged against medical advice (DAMA). This article is a study of the prevalence of the problem, the possible causes and/or risk factors.Materials and Methods:A retrospective review of 10 years of medical records of neonates discharged against medical advice from a Neonatal Intensive Care Unit (NICU) at a university hospital.Results:The overall prevalence of DAMA was 1.6%. Most of the 51 infants who were taken out of hospital against medical advice (AMA) were term (72.5%) with a mean gestational age of 37.78 ± 2.5 weeks, of normal birth weight, with a mean of 2736 ± 661 g, Saudis (96%), those delivered vaginally (69%), and those that were provisionally diagnosed with transient tachypnea of newborn (TTN) and/or query sepsis (49%). There was no difference between males and females (M/F = 1.2). There was an association between DAMA and the timing of DAMA (27.5% of DAMA at weekends and 67% of DAMA from May to October).Conclusion:DAMA of neonates is particularly critical. The causes and risk factors are many and difficult to predict. In addition to several other factors, its prevalence is influenced negatively by some socio-cultural beliefs.

Discharge against Medical Advice at Neonatal Intensive Care Unit in Gujarat, India

“…This finding corroborates with other studies in pediatric [7, 9, 11] as well as neonatal populations [12, 13]. …”

“…DAMA not only raises clinical, ethical, and legal issues for the treating physician [4] but also leads to adverse health outcomes thereby burdening the health system even more [5]. There have been few attempts by developing economies to document the extent of the problem as well as the reasons behind DAMA in pediatric population [6–11] and neonates [12, 13]. The studies in pediatric populations indicated that the problem is more prevalent in neonates.…”

Discharge against medical advice in culturally and linguistically diverse Australian children

“…Among the CALD groups, families of neonates were also found to be more likely to DAMA than families of children from other age groups, although this was not explored further in the dataset. Previous research has identified reasons for this observation, including children delivered vaginally with early ambulation of their mothers, families’ duty to care for other children at home and their false impressions that the child had improved 6 23…”

“…Similar difficulties were also experienced by immigrants from non-English speaking countries who were identified as CALD. When attending EDs in Australia, only 36% of patients who had limited English proficiency were provided trained interpreters 23. In the paediatric setting, 26% of CALD parents identified language as the single greatest barrier to accessing healthcare in the USA 24…”

Risk Factors and Reasons for Discharge Against Medical Advice for Newborns With Neonatal Surgical Diseases: A Preliminary Study From a Tertiary Care Hospital in Beijing, China

“…Congenital malformations, the most common neonatal surgical diseases, are a leading cause of mortality and morbidity in the neonatal period and infancy besides labor associated problems like asphyxia and prematurity ( 2 ). Approximately 2.5–5% of all neonates have at least one anatomical malformation ( 3 ), but the spectrum of this heterogeneous group of diseases is very wide.…”