Contenuto dell'articolo principale
Abstract
INTRODUZIONE: La continuitaÌ€ assistenziale nel periodo postpartum, in particolare in caso di dimis- sione precoce, è fortemente raccomandata dalle linee-guida internazionali. Un follow-up individualizzato puoÌ€ diminuire morbiditaÌ€ e mortalitaÌ€ del neonato e prevenire/iden- tificare precocemente problemi a lungo termine per madre, neonato e famiglia.Le ultime raccomandazioni italiane per l'assistenza postpartum risalgono al 2000.
SCOPO: Descrivere l'organizzazione del follow-up dei neonati sani a termine post-dimissione da parte dei centri nascita degli ospedali pubblici liguri.
Metodo: Studio descrittivo, condotto nel 2015 tramite intervista telefonica rivolta a coordinatori infermieristici (o sostituti) dei dieci centri nascita degli ospedali pubblici liguri.
RISULTATI: Tutti i centri hanno risposto. Tutti raccomandano una visita di follow-up, ma solo la metà dispone di una procedura per il percorso.
La maggior parte raccomanda la prima visita entro 2-3 giorni dalla dimissione. La metaÌ€ prevede la prima visita di follow-up presso l'ambulatorio del centro nascita; tre centri nascita non raccoman- dano ulteriori visite. Nessuno dei centri fa coincidere la visita di follow-up del neonato con il controllo postpartum della madre neÌ considera la diade madre-neonato come unitaÌ€; in genere i bisogni di madre/neonato sono individuati e soddisfatti da infermiere pediatrico/infermiere e neonatologo. Tutti i centri forniscono il recapito telefonico della unitaÌ€ operativa e otto quello dell'ambulatorio; in due centri si contattano telefonicamente le madri considerate a rischio di depressione postpartum, e in uno si comunicano telefonicamente i risultati degli screening meta- bolici, cogliendo l'occasione per informarsi sulla situazione della famiglia.
DISCUSSIONE: Lo studio descrive differenti modalità di organizzazione del percorso di follow-up tra i centri nascita liguri, in particolare riguardo tempistica e organizzazione delle visite.
Al momento non vi è una attuazione omogenea degli interventi raccomandati a livello nazionale, in particolare per quanto riguarda l'organizzazione dell'assistenza territoriale (ruolo dei consultori familiari, servizi di consulenza telefonica, precoce presa in carico dal pediatra di libera scelta).
PAROLE CHIAVE: cure postnatali; cure postpartum; dimissione; neonato; linee guida
Survey on follow-up of new born babies after the discharge from the birth centres of the Ligurian public hospitals
ABSTRACT
INTRODUCTION: Continuity of care in the postpartum period is strongly recommended by inter- national guidelines.
Several studies demonstrate how an individualized follow-up program may decrease newborn's mortality and morbidity and prevent or early identify chronic diseases or diseases with long-term effects for mother, newborn and family.
In Italy the lastest recommendations on postnatal care of mothers and newborns have been relea- sed in 2000.
AIM: To describe the organization of healthy term newborns post-discharge follow-up in the 10 birth centers of Ligurian public hospitals.
METHODS: Descriptive study, conducted in 2015 through telephonic interview with head nurses (or their delegates) of the centers.
RESULTS: All 10 birth centers participated in the study recommend a follow-up visit, but only half have a formalized procedure for follow-up. Most of them recommend the first follow-up visit within 2-3 days from discharge. Half of centers provide the first follow-up visit at the birth center's clinic, three don't recommend follow-up visits after the first one. None of them links the follow-up visit of the newborn with the mother's one; usually the needs of mother and newborn are identified and met by pediatric nurses, nurses and neonatologist. All the centers provide a telephone number for post-discharge needs. Two centers make calls to mothers considered to be at risk of postpartum depression.
DISCUSSION: The study describes different newborn care pathways related to follow-up after discharge in the Ligurian birth centers. At the moment there is no homogeneous implementation of the interventions recommended at national level.
KEYWORDS: Patient discharge; infant newborn; postnatal care; postpartum care; guideline
Dettagli dell'articolo
Riferimenti
- Academy of Breastfeeding Medicine, Evans A, Marinelli KA, Taylor JS (2014). ABM clinical protocol #2: guidelines for hospital dischargeof the breastfeeding term newborn and mother: "˜"˜the going home protocol''. Breastfeeding Medicine. 9(1): 4-8.
- Agenzia Sanitaria Regionale dell'Emilia Romagna (2006). Il profilo assistenziale del neonato sano. Bologna: Dossier. 137.
- Askelsdottir B, Lam-de Jonge W, Edman G, Wiklund I (2012). Home care after early discharge: impact on healthy mothers and newborns. Midwifery. (29): 927-934.
- Baker B, McGrath JM, Pickler R, Jallo N, Cohen S (2014). Competence and responsiveness in mothers of late preterm infants versus term infants. Journal of Obstetric, Gynecologic & Neonatal Nursing. 42 (3): 301-310.
- Benitz WE, Committee on fetus and newborn (2015). Hospital stay for healthy term newborn infants. Pediatrics. 135(5): 948-53. Bennett RL, Tandy LJ (1998). Postpartum home visits: extending the continuum of care from hospital to home. Home
- Healthcare Nurse. 16(5): 295-303.
- Bernstein HH, Spino C, Finch S, Waaserman R, Slora E, Lalama C,
- Touloukian CL, Lilienfeld H, McCormick MC (2007). Decision-making for postpartum discharge of 4300 mothers and their healthy infants: the life around newborn discharge study. Pediatrics. 120(2): e391-e400.
- Bravo P, Uribe C, Contreras A (2011). Early postnatal hospital discharge: the consequences of reducing length of stay for women and newborns. Revista da Escola de Enfermagem USP. 45(3): 758-763.
- Brown S, Small R, Argus B, Davis PG, Krastev A (2002). Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database of Systematic Reviews. Issue 3.
- Brumfield CG, Ashworth CS, Lea C, Sims J, Yarbaugh D, Cliver SP (2009). Early discharge revisited: problems encountered with the home visit follow-up after the liberalization of eligibility criteria. Journal of Maternal-Fetal Medicine. 10(4): 277-282.
- Di Giacomo P, Rigon LA (2016) Assistenza infermieristica e ostetrica in area materno-infantile – 2° ed. Milano: Casa Editrice Ambrosiana.
- Demott K, Bick D, Norman R, Ritchie G, Turnbull N, Adams C, Barry C, Byrom S, Elliman D, Marchant S, Mccandlish R, Mellows H, Neale C, Parkar M, Tait P, Taylor C (2006). Clinical guidelines and evidence review for post natal care: routine post natal care of recently delivered women and their babies. London: National Collaborating Centre For Primary Care And Royal College Of General Practitioners. Disponibile da: https://www.nice.org.uk/guidance/cg37/evidence/full- guideline-485782237 [Consultato il 4 gennaio 2018].
- Dennis CL, Kingston D (2008). A systematic review of telephone support for women during pregnancy and the early postpartum period. Journal of Obsteric, Gynecologic and Neonatal Nursing. (37): 301-314.
- Escobar GJ, Braveman PA, Ackerson L, Odouli R, Coleman-Phox K, Capra AM, Wong C, Lieu TA (2001). A randomized comparison of home visits and hospital-based group follow-up visits after early postpartum discharge. Pediatrics. 108(3): 719- 727.
- Galbraith AA, Egerter SA, Marchi KS, Chavez G, Braveman PA (2003). Newborn early discharge revisited: are California newborns receiving recommended postnatal service? Pediatrics. 111(2): 364-371.
- Grullon KE, Grimes DA (1997). The safety of early postpartum discharge: a review and critique. The American College of Obstetricians and Gynecologists. 90(5): 860-865.
- Gupta P, Malhotra S, Dharmendra KS, Tarun D (2006). Length of postnatal stay in healthy newborns and re-hospitalization following their early discharge. Indian Journal of Pediatrics. 73(10): 897-900.
- Hascoet JM, Petitprez K (2014). Sortie de la materniteÌ: conditions et organization du retour aÌ€ domicile des mères et de leurs nouveau-neÌs. Mise aÌ€ jour des recommandations de la Haute AutoriteÌ de santeÌ. Archives Pediatrics & Adolescent Medicine.12(9): 1053-1059.
- Haran C, Van Driel M, Mitchell BL, Brodribb WE (2014). Clinical guidelines for postpartum women and infants in primary care–a systematic review. I 14:51.
- Isetta V, Lopez-Augustina C, Lopez-Bernal E, Amat M, Vila M, Valls C, Navajas D, Farre R (2013). Cost-effectiveness of a new internet-based monitoring tool for neonatal post- discharge home care. Journal of Medical Internet Research. 15(2): e38.
- Jiang H, Wen ML, Hu Q, Yang D, He G, Baur LA, Dibley MJ,
- Qian X (2014).Effect of short message service on infant
- feeding practice. JAMA Pediatrics. 168(5): 471-478. Jirojwong S, Rossi D, Walker S, Ritchie B (2005). What were the outcomes of home follow-up visits after postpartum hospital discharge? Australian Journal of Advanced Nursing. 23(1): 22-
- Kiely M, Drum MA, Kessel W (1998). Early discharge. Risks,
- benefits and who decides. Clinics in Perinatology. 25(2): 471-481. Kronborg H, Vaeth M, Kristensen I (2012). The effect of early postpartum home visits by health visitors: a natural
- experiment. Public Health Nursing. 29(4): 289-301.
- Kurth E, Kennedy HP, Spichiger E, Hosli I, Stutz EZ (2011). Crying baby, tired mothers: what do we know? A systematic
- review. Midwifery. 27(2): 187-194.
- Lain SJ, Roberts CL, Bowen JR, Nassar N (2015). Early discharge
- of infants and risk of readmission for jaundice. Pediatrics.
- (2): 314-321.
- Lavender T, Richens Y, Milan SJ, Smyth RMD, Dowswell T (2013).
- Telephone support for women during pregnancy and the first six weeks portpartum (Review). Cochrane Database of Systematic Reviews. Issue 7.
- Lieu TA, Braveman PA, Escobar GJ, Fischer AF, Jensvold NG, Capra AM (2000). A randomized comparison of home clinic follow-up visits after early postpartum hospital discharge. Pediatrics. 105(5): 1058-1065.
- Meara E, Kotagal UR, Atherton HD, Lieu TA (2004). Impact of early newborn discharge legislation and early follow-up visits on infant outcomes in a state Medicaid population. Pediatrics. 113(6): 1619-1627.
- NICE National Institute for Health and Care Excellence (2015). Postnatal care.NICE clinical guideline 37. NICE, UK.
- Oh W, Merenstein G (1997). Fourth edition of the guidelines for perinatal care: summary of changes. Pediatrics. 100(6): 1021- 1022.
- OMS - Organizzazione Mondiale della Sanità (2006). Pregnancy, childbirth, postpartum and newborn care: a guide for essential
- practice. Geneva: WHO Press.
- OMS - Organizzazione Mondiale della Sanità (2013). Postnatal care
- of the mother and newborn. Geneva: WHO Press. OMS/UNICEF - Organizzazione Mondiale della Sanità e United Nations Children's Fund (2009). Joint statement. Home visits for the newborn child: a strategy to improve survival. WHO
- Press.
- Paul IM, Beiler JS, Schaefer EW, Hollenbeak CS, Alleman N,
- Sturgis SA, Yu SM, Camacho FT, Weisman CS (2011). A randomized trial of single home nursing visits vs office-based care after nursing/maternity discharge. Archives Pediatrics & Adolescent Medicine. 166(3): 263-270.
- Petrone E, Mansi G, Tosco A, Capasso L, Migliaro F, Umbaldo A, Romano A, Paludetto R, Raimondi F (2008). Early hospital discharge of healthy term neonate: the Italian perspective. Minerva Pediatrica. 60(3): 273-276.
- Rapisardi G, Pierattelli M, Tamburlini G (2000). Raccomandazioni per l'assistenza alla madre in puerperio e al neonato. Disponibile da: http://www.acp.it/wp-content/uploads/LG- assistenza-madre-neonato.pdf [Consultato il 4 gennaio 2018].
- Sawyer A, Lynch J, Bowering K, Jeffs D, Clark J, Mpundu- Kaambwa C (2014). An equivalence evaluation of a nurse- moderated group-based internet support program for new mothers versus standard care: a pragmatic preference randomised controlled trial. BioMed Central Pediatrics.14:119.
- Shaw E, Levitt C, Wong S, Kaczorowski J, The McMaster University Postpartum Research Group (2006). Systematic review of the literature on postpartum care: effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. Birth. 33(3): 210- 220.
- Yonemoto N, Dowswell T, Nagai S, Mori R (2013). Schedulesfor home visitsin the early postpartum period. Cochrane Database of Systematic Reviews. Issue 7.
- Volante E, Grignaffini A, Izzi GC, Salvini P (2000). Progetto di dimissione precoce appropriata del neonato sano. Acta Bio- Medica de l'Ateneo Parmense. 71 (Supplemento 1): 675-680.
Riferimenti
Academy of Breastfeeding Medicine, Evans A, Marinelli KA, Taylor JS (2014). ABM clinical protocol #2: guidelines for hospital dischargeof the breastfeeding term newborn and mother: "˜"˜the going home protocol''. Breastfeeding Medicine. 9(1): 4-8.
Agenzia Sanitaria Regionale dell'Emilia Romagna (2006). Il profilo assistenziale del neonato sano. Bologna: Dossier. 137.
Askelsdottir B, Lam-de Jonge W, Edman G, Wiklund I (2012). Home care after early discharge: impact on healthy mothers and newborns. Midwifery. (29): 927-934.
Baker B, McGrath JM, Pickler R, Jallo N, Cohen S (2014). Competence and responsiveness in mothers of late preterm infants versus term infants. Journal of Obstetric, Gynecologic & Neonatal Nursing. 42 (3): 301-310.
Benitz WE, Committee on fetus and newborn (2015). Hospital stay for healthy term newborn infants. Pediatrics. 135(5): 948-53. Bennett RL, Tandy LJ (1998). Postpartum home visits: extending the continuum of care from hospital to home. Home
Healthcare Nurse. 16(5): 295-303.
Bernstein HH, Spino C, Finch S, Waaserman R, Slora E, Lalama C,
Touloukian CL, Lilienfeld H, McCormick MC (2007). Decision-making for postpartum discharge of 4300 mothers and their healthy infants: the life around newborn discharge study. Pediatrics. 120(2): e391-e400.
Bravo P, Uribe C, Contreras A (2011). Early postnatal hospital discharge: the consequences of reducing length of stay for women and newborns. Revista da Escola de Enfermagem USP. 45(3): 758-763.
Brown S, Small R, Argus B, Davis PG, Krastev A (2002). Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database of Systematic Reviews. Issue 3.
Brumfield CG, Ashworth CS, Lea C, Sims J, Yarbaugh D, Cliver SP (2009). Early discharge revisited: problems encountered with the home visit follow-up after the liberalization of eligibility criteria. Journal of Maternal-Fetal Medicine. 10(4): 277-282.
Di Giacomo P, Rigon LA (2016) Assistenza infermieristica e ostetrica in area materno-infantile – 2° ed. Milano: Casa Editrice Ambrosiana.
Demott K, Bick D, Norman R, Ritchie G, Turnbull N, Adams C, Barry C, Byrom S, Elliman D, Marchant S, Mccandlish R, Mellows H, Neale C, Parkar M, Tait P, Taylor C (2006). Clinical guidelines and evidence review for post natal care: routine post natal care of recently delivered women and their babies. London: National Collaborating Centre For Primary Care And Royal College Of General Practitioners. Disponibile da: https://www.nice.org.uk/guidance/cg37/evidence/full- guideline-485782237 [Consultato il 4 gennaio 2018].
Dennis CL, Kingston D (2008). A systematic review of telephone support for women during pregnancy and the early postpartum period. Journal of Obsteric, Gynecologic and Neonatal Nursing. (37): 301-314.
Escobar GJ, Braveman PA, Ackerson L, Odouli R, Coleman-Phox K, Capra AM, Wong C, Lieu TA (2001). A randomized comparison of home visits and hospital-based group follow-up visits after early postpartum discharge. Pediatrics. 108(3): 719- 727.
Galbraith AA, Egerter SA, Marchi KS, Chavez G, Braveman PA (2003). Newborn early discharge revisited: are California newborns receiving recommended postnatal service? Pediatrics. 111(2): 364-371.
Grullon KE, Grimes DA (1997). The safety of early postpartum discharge: a review and critique. The American College of Obstetricians and Gynecologists. 90(5): 860-865.
Gupta P, Malhotra S, Dharmendra KS, Tarun D (2006). Length of postnatal stay in healthy newborns and re-hospitalization following their early discharge. Indian Journal of Pediatrics. 73(10): 897-900.
Hascoet JM, Petitprez K (2014). Sortie de la materniteÌ: conditions et organization du retour aÌ€ domicile des mères et de leurs nouveau-neÌs. Mise aÌ€ jour des recommandations de la Haute AutoriteÌ de santeÌ. Archives Pediatrics & Adolescent Medicine.12(9): 1053-1059.
Haran C, Van Driel M, Mitchell BL, Brodribb WE (2014). Clinical guidelines for postpartum women and infants in primary care–a systematic review. I 14:51.
Isetta V, Lopez-Augustina C, Lopez-Bernal E, Amat M, Vila M, Valls C, Navajas D, Farre R (2013). Cost-effectiveness of a new internet-based monitoring tool for neonatal post- discharge home care. Journal of Medical Internet Research. 15(2): e38.
Jiang H, Wen ML, Hu Q, Yang D, He G, Baur LA, Dibley MJ,
Qian X (2014).Effect of short message service on infant
feeding practice. JAMA Pediatrics. 168(5): 471-478. Jirojwong S, Rossi D, Walker S, Ritchie B (2005). What were the outcomes of home follow-up visits after postpartum hospital discharge? Australian Journal of Advanced Nursing. 23(1): 22-
Kiely M, Drum MA, Kessel W (1998). Early discharge. Risks,
benefits and who decides. Clinics in Perinatology. 25(2): 471-481. Kronborg H, Vaeth M, Kristensen I (2012). The effect of early postpartum home visits by health visitors: a natural
experiment. Public Health Nursing. 29(4): 289-301.
Kurth E, Kennedy HP, Spichiger E, Hosli I, Stutz EZ (2011). Crying baby, tired mothers: what do we know? A systematic
review. Midwifery. 27(2): 187-194.
Lain SJ, Roberts CL, Bowen JR, Nassar N (2015). Early discharge
of infants and risk of readmission for jaundice. Pediatrics.
(2): 314-321.
Lavender T, Richens Y, Milan SJ, Smyth RMD, Dowswell T (2013).
Telephone support for women during pregnancy and the first six weeks portpartum (Review). Cochrane Database of Systematic Reviews. Issue 7.
Lieu TA, Braveman PA, Escobar GJ, Fischer AF, Jensvold NG, Capra AM (2000). A randomized comparison of home clinic follow-up visits after early postpartum hospital discharge. Pediatrics. 105(5): 1058-1065.
Meara E, Kotagal UR, Atherton HD, Lieu TA (2004). Impact of early newborn discharge legislation and early follow-up visits on infant outcomes in a state Medicaid population. Pediatrics. 113(6): 1619-1627.
NICE National Institute for Health and Care Excellence (2015). Postnatal care.NICE clinical guideline 37. NICE, UK.
Oh W, Merenstein G (1997). Fourth edition of the guidelines for perinatal care: summary of changes. Pediatrics. 100(6): 1021- 1022.
OMS - Organizzazione Mondiale della Sanità (2006). Pregnancy, childbirth, postpartum and newborn care: a guide for essential
practice. Geneva: WHO Press.
OMS - Organizzazione Mondiale della Sanità (2013). Postnatal care
of the mother and newborn. Geneva: WHO Press. OMS/UNICEF - Organizzazione Mondiale della Sanità e United Nations Children's Fund (2009). Joint statement. Home visits for the newborn child: a strategy to improve survival. WHO
Press.
Paul IM, Beiler JS, Schaefer EW, Hollenbeak CS, Alleman N,
Sturgis SA, Yu SM, Camacho FT, Weisman CS (2011). A randomized trial of single home nursing visits vs office-based care after nursing/maternity discharge. Archives Pediatrics & Adolescent Medicine. 166(3): 263-270.
Petrone E, Mansi G, Tosco A, Capasso L, Migliaro F, Umbaldo A, Romano A, Paludetto R, Raimondi F (2008). Early hospital discharge of healthy term neonate: the Italian perspective. Minerva Pediatrica. 60(3): 273-276.
Rapisardi G, Pierattelli M, Tamburlini G (2000). Raccomandazioni per l'assistenza alla madre in puerperio e al neonato. Disponibile da: http://www.acp.it/wp-content/uploads/LG- assistenza-madre-neonato.pdf [Consultato il 4 gennaio 2018].
Sawyer A, Lynch J, Bowering K, Jeffs D, Clark J, Mpundu- Kaambwa C (2014). An equivalence evaluation of a nurse- moderated group-based internet support program for new mothers versus standard care: a pragmatic preference randomised controlled trial. BioMed Central Pediatrics.14:119.
Shaw E, Levitt C, Wong S, Kaczorowski J, The McMaster University Postpartum Research Group (2006). Systematic review of the literature on postpartum care: effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. Birth. 33(3): 210- 220.
Yonemoto N, Dowswell T, Nagai S, Mori R (2013). Schedulesfor home visitsin the early postpartum period. Cochrane Database of Systematic Reviews. Issue 7.
Volante E, Grignaffini A, Izzi GC, Salvini P (2000). Progetto di dimissione precoce appropriata del neonato sano. Acta Bio- Medica de l'Ateneo Parmense. 71 (Supplemento 1): 675-680.