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• W2149606771 abstract "We read with interest the recent article by Kotagal et al.1Kotagal UR Perlstein PH Gamblian V Donovan EF Atherton HD Description and evaluation of a program for the early discharge of infants from a neonatal intensive care unit.J PEDIATR. 1995; 127: 285-290Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar regarding a early discharge program from a neonatal intensive care unit (NICU). We studied patients discharged from our NICU during the last 15 years. Since 1980 we have used a follow-up program consisting of regular social worker contacts for patients in need, and monthly Pediatrician plus neurodevelopmental clinic follow-up, combined with initial training programs where most mothers stayed for 1 to 2 weeks with their children in the NICU (24-hour basis). Analysis of our results (Table) showed a decrease in the neonatal mortality rate, as described by others.2Ihle W Chances of survival of very low birth weight infants—trends and actual problems exemplary demonstrate for the years 1970-1989.in: Research in perinatal medicine 3. Ullstein-Mosby, Berlin1991Google Scholar The in-hospital training, social work, and free ambulatory health care program initially seemed to be somewhat successful because, at the least, the postneonatal infant mortality rate decreased from 2.2% to 0.9% of all children born excluding cases of sudden infant death syndrome (SIDS) (approximately another 2%). Our facility is the only neonatal facility for a region with 6000 births per year. At the same time we reduced the average weight of children discharged from the hospital and thus reduced hospital stays, even when the discharge weights were corrected for gestational age. We interpreted these findings as successes, in accordance with other publications.3Black MM Dubowitz H Hutcheson J Berenson-Howard J Starr RH A randomized clinical trial of home intervention for children with failure to thrive.Pediatrics. 1995; 95: 807-814PubMed Google Scholar, 4Olds D Henderson CR Kitzman H Cole R Effects of prenatal and infancy nurse home visitation on surveillance of child maltreatment.Pediatrics. 1995; 95: 365-372PubMed Google Scholar Tabled 1Table. Summary of neonatal and postneonatal mortality rates (1980-1995)Neonatal mortalityPostneonatal mortalityAverage weight atYearrate (%)rate (%)Ratiodischarge (gm)19806.52.22.9280019854.20.94.7250019902.00.92.2230019951.771.51.12000 Open table in a new tab During the past 5 years, however, we realized a new increase in the postneonatal mortality rate. This issue was of special concern because it grew to major political importance because the neonatal in-hospital mortality rate (during the first 28 days of life) was now as low as the postneonatal rate (excluding SIDS). Even the SIDS mortality rate decreased to 1.5%. Reducing the neonatal and SIDS mortality rates were the primary topics of German health politics for the last several decades. An analysis of the individual postneonatal deaths showed that all patients were former NICU patients, and that neglect (starvation, too-late therapy for dehydration, bronchiolitis, and so on) was a significant factor in all deaths. In all cases social workers and physicians had contact with the patients at least 2 weeks before death. Our study shows that early discharge programs may fail. We adopted continuous care coordination and close contact of social and health care providers with better training of these workers in cooperation with public health authorities to improve an unacceptable situation. Of course, early discharge programs provide a chance for creating partnerships5Gershan LA Kliegman RM Early discharge of low birth weight infants: an opportunity to evolve and to create partnerships.J PEDIATR. 1995; 127: 272-274Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar; however, establishment of an efficacious, not merely expensive, program requires continuous reevaluation, competence in Pediatric knowledge, and coordination with daily health care provider visits in families of lower socioeconomic status. 9/35/71116" @default.
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• W2149606771 title "Possible risks of early discharge of neonates from a neonatal intensive care unit" @default.
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• W2149606771 doi "https://doi.org/10.1016/s0022-3476(96)70314-1" @default.
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