Postnatal Discharge Research Articles

Perinatal Risk and Protective Factors for Pediatric Abusive Head Trauma: A Multicenter Case-Control Study

To estimate associations between factors recorded in pregnancy and the first week of life and subsequent abusive head trauma. Multicenter, retrospective case-control study of perinatal records from 142 cases of abusive head trauma and 550 controls, matched by date and hospital of birth from 1991 to 2010. Multiple logistic regression assessed the relationship between perinatal exposures and abusive head trauma. The risk of abusive head trauma decreased with increasing maternal age (OR, 0.91 per year; 95% CI 0.85-0.97) and increasing gestational age at birth (OR 0.79 per week; 95% CI 0.69-0.91). Mothers of cases were more likely to be Māori (OR 4.61; 95% CI 1.98-10.78), to be single (OR 5.10; 95% CI 1.83-14.23), have recorded social concerns (OR 4.29; 95% CI 1.32-13.91), and have missing data for antenatal care, partner status, social concerns, and substance abuse (OR 13.53; 95% CI 2.39-76.47). Case mothers were more likely not to take supplements in pregnancy (OR 3.53; 95% CI 1.30-9.54), to have membrane rupture longer than 48 hours before delivery (OR 13.01; 95% CI 2.84-59.68), and to formula feed (OR for mixed breast and formula feeding 6.06; 95% CI 2.39-15.36) before postnatal discharge (median 3 days). Factors associated with subsequent abusive head trauma can be identified from routine perinatal records. Targeted interventions initiated perinatally could possibly prevent some cases of abusive head trauma. However, any plans for targeted prevention strategies should consider not only those with identified risk factors but also those for which data are missing.

Development and validation of Prediction models for Risks of complications in Early-onset Pre-eclampsia (PREP): a prospective cohort study.

The prognosis of early-onset pre-eclampsia (before 34 weeks' gestation) is variable. Accurate prediction of complications is required to plan appropriate management in high-risk women. To develop and validate prediction models for outcomes in early-onset pre-eclampsia. Prospective cohort for model development, with validation in two external data sets. Model development: 53 obstetric units in the UK. Model transportability: PIERS (Pre-eclampsia Integrated Estimate of RiSk for mothers) and PETRA (Pre-Eclampsia TRial Amsterdam) studies. Pregnant women with early-onset pre-eclampsia. Nine hundred and forty-six women in the model development data set and 850 women (634 in PIERS, 216 in PETRA) in the transportability (external validation) data sets. The predictors were identified from systematic reviews of tests to predict complications in pre-eclampsia and were prioritised by Delphi survey. The primary outcome was the composite of adverse maternal outcomes established using Delphi surveys. The secondary outcome was the composite of fetal and neonatal complications. We developed two prediction models: a logistic regression model (PREP-L) to assess the overall risk of any maternal outcome until postnatal discharge and a survival analysis model (PREP-S) to obtain individual risk estimates at daily intervals from diagnosis until 34 weeks. Shrinkage was used to adjust for overoptimism of predictor effects. For internal validation (of the full models in the development data) and external validation (of the reduced models in the transportability data), we computed the ability of the models to discriminate between those with and without poor outcomes (c-statistic), and the agreement between predicted and observed risk (calibration slope). The PREP-L model included maternal age, gestational age at diagnosis, medical history, systolic blood pressure, urine protein-to-creatinine ratio, platelet count, serum urea concentration, oxygen saturation, baseline treatment with antihypertensive drugs and administration of magnesium sulphate. The PREP-S model additionally included exaggerated tendon reflexes and serum alanine aminotransaminase and creatinine concentration. Both models showed good discrimination for maternal complications, with anoptimism-adjusted c-statistic of 0.82 [95% confidence interval (CI) 0.80 to 0.84] for PREP-L and 0.75 (95% CI 0.73 to 0.78) for the PREP-S model in the internal validation. External validation of the reduced PREP-L model showed good performance with a c-statistic of 0.81 (95% CI 0.77 to 0.85) in PIERS and 0.75 (95% CI 0.64 to 0.86) in PETRA cohorts for maternal complications, and calibrated well with slopes of 0.93 (95% CI 0.72 to 1.10) and 0.90 (95% CI 0.48 to 1.32), respectively. In the PIERS data set, the reduced PREP-S model had a c-statistic of 0.71 (95% CI 0.67 to 0.75) and a calibration slope of 0.67 (95% CI 0.56 to 0.79). Low gestational age at diagnosis, high urine protein-to-creatinine ratio, increased serum urea concentration, treatment with antihypertensive drugs, magnesium sulphate, abnormal uterine artery Doppler scan findings and estimated fetal weight below the 10th centile were associated with fetal complications. The PREP-L model provided individualised risk estimates in early-onset pre-eclampsia to plan management of high- or low-risk individuals. The PREP-S model has the potential to be used as a triage tool for risk assessment. The impacts of the model use on outcomes need further evaluation. Current Controlled Trials ISRCTN40384046. The National Institute for Health Research Health Technology Assessment programme.

Early discharge following birth – What characterises mothers and newborns?

BackgroundEarly postnatal discharge has increased over the past 50 years and today we lack the knowledge on who is discharged early that would allow us to improve quality of postnatal care. The aim of this study was to describe maternal and infant predictors for early postnatal discharge in a country with equal access to health care. MethodsAn observational study of 2786 mothers, recruited in pregnancy was conducted from April 2013 to August 2014 in four of the five regions in Denmark. Data were analysed using Kaplan–Meier method and multinomial regression models. Outcome variable was time of discharge after birth. ResultsIn total 34% mothers were discharged within 12 hours (very early) and 25% between 13 and 50 hours (early), respectively. Vaginal birth and multiparity were the most influential predictors, as Caesarean section compared to vaginal birth had an OR of 0.35 (CI 0.26–0.48) and primiparous compared to multiparous had an OR of 0.22 (CI 0.17–0.29) for early discharge. Other predictors for early discharge were: no induction of labour, no epidural painkiller, bleeding less than 500 ml during delivery, higher gestational age, early expected discharge and positive breastfeeding experience. Smoking, favourable social support and breastfeeding knowledge were significantly associated with discharge within 12 hours. Finally time of discharge varied significantly according to region and time of day of birth. ConclusionsParity and birth related factors were the strongest predictors of early discharge. Psycho-social predictors indicate that the parents are involved in the decision of when to be discharge.

Improving flow of patients on maternity ward – a Quality Improvement Project

The necessity for quality and safety improvement initiatives permeates health care. A high quality healthcare system should be safe, effective, patient centred, timely and efficient. In order to achieve this, health services need to continually evaluate themselves and improve the way they work. We are carrying out a Quality Improvement Project to improve patient flow on the Maternity Ward. It is based at Leicester General Hospital, UK which has about 4000 deliveries per year. The hospital maternity ward has 35 beds and postnatal patients occupy 75% of these at most times. Guided by the Pareto principle, we have decided to focus on improving flow of post natal patients through the ward. The first step of our project was to map the journey of a post natal patient through the ward. We studied notes of 25 patients who had been discharged in the past week with the aim to identify bottlenecks in the discharge process where change could be implemented. We were keen to break down traditional hierarchies for this project to ensure that all perspectives and ideas were considered. So we conducted three spot surveys of ward staff such as midwives, student midwives, healthcare assistants and non-clinical staff who are often the first point of contact for patients. The staffs were asked to put forward any ideas and suggestions to improve patient flow through the ward. The suggestions included increasing midwifery staffing levels, having a dedicated ward doctor, a dedicated staff member for administrative tasks including completing discharge summaries, expanding the roles of staff members such as the healthcare assistants and housekeepers. The results of the staff survey were presented to senior staff members whose experience helped us to weigh up each idea. We realized that in the present day climate of the NHS with its many financial constraints, hiring more staff was not an option. The suggestion of having a dedicated ward doctor was well received. This could help streamline and speed up the discharge process by ensuring timely review of patients, and medication prescription. We conducted an anonymous survey of ward staff and junior doctors putting forward this idea and received a positive response. In response to another survey question, 100% of the respondents also indicated that the present postnatal patient discharge system needed change and reorganisation. At present we are working on implementing this change in our unit. Once this PDSA (Plan, Study, Do and Act) cycle has been completed, we will conduct staff surveys to assess satisfaction level with this change and compare it to the previous survey results. We will also compare patient discharge timeline to the previously collected data and see if the change has resulted in shortening the discharge timing. We hope to achieve a sustainable change which makes a real difference to patient care in the maternity ward and ultimately has a positive impact on patient safety.

Breastfeeding initiation and support: A literature review of what women value and the impact of early discharge

Early discharge following birth has become an emerging phenomenon in many countries. It is likely early discharge has an impact on the establishment of breastfeeding. To critically appraise the evidence on what women value in relation to breastfeeding initiation and support, and investigate the impact early discharge can have on these values. A literature search was conducted for publications since 2005 using the following databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Scopus and PsycINFO; 21 primary articles were selected and included in the review. There is no standard definition for 'early discharge' worldwide. Due to inconsistent definitions worldwide and minimal literature using a 24h definition, research defining early discharge as up to 72h postpartum is included. Seven key factors in relation to breastfeeding initiation and support following early discharge were identified, namely trust and security, consistent advice, practical breastfeeding support, breastfeeding education, comfortable environment, positive attitudes and emotional support, and individualised care. The findings suggest individualised postnatal lengths of stay may be beneficial for the initiation of breastfeeding. Five values were not impacted by early discharge, but rather individual midwives' practice. There is consensus in the literature that early discharge promoted a comfortable environment to support breastfeeding initiation. Wide variations in the definition of early postnatal discharge made it difficult to draw influential conclusions. Therefore, further research is required.

The effect of early postnatal discharge from hospital for women and infants: a systematic review protocol.

BackgroundThe length of postnatal hospital stay has declined over the last 40 years. There is little evidence to support a policy of early discharge following birth, and there is some concern about whether early discharge of mothers and babies is safe. The Cochrane review on the effects of early discharge from hospital only included randomised controlled trials (RCTs) which are problematic in this area, and a systematic review including other study designs is required. The aim of this broader systematic review is to determine possible effects of a policy of early postnatal discharge on important maternal and infant health-related outcomes.Methods/designA systematic search of published literature will be conducted for randomised controlled trials, non-randomised controlled trials (NRCTs), controlled before-after studies (CBA), and interrupted time series studies (ITS) that report on the effect of a policy of early postnatal discharge from hospital. Databases including Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and Science Citation Index will be searched for relevant material. Reference lists of articles will also be searched in addition to searches to identify grey literature. Screening of identified articles and data extraction will be conducted in duplicate and independently. Methodological quality of the included studies will be assessed using the Effective Practice and Organisation of Care (EPOC) criteria for risk of bias tool. Discrepancies will be resolved by consensus or by consulting a third author. Meta-analysis using a random effects model will be used to combine data. Where significant heterogeneity is present, data will be combined in a narrative synthesis. The findings will be reported according to the preferred reporting items for systematic reviews (PRISMA) statement.DiscussionInformation on the effects of early postnatal discharge from hospital will be important for policy makers and clinicians providing maternity care. This review will also identify any gaps in the current literature on this topic and provide direction for future research in this area of study.Systematic review registrationPROSPERO CRD42015020545Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0193-9) contains supplementary material, which is available to authorized users.

Post-test probability for neonatal hyperbilirubinemia based on umbilical cord blood bilirubin, direct antiglobulin test, and ABO compatibility results.

Many hospitals opt for early postnatal discharge of newborns with a potential risk of readmission for neonatal hyperbilirubinemia. Assays/algorithms with the possibility to improve prediction of significant neonatal hyperbilirubinemia are needed to optimize screening protocols and safe discharge of neonates. This study investigated the predictive value of umbilical cord blood (UCB) testing for significant hyperbilirubinemia. Neonatal UCB bilirubin, UCB direct antiglobulin test (DAT), and blood group were determined, as well as the maternal blood group and the red blood cell antibody status. Moreover, in newborns with clinically apparent jaundice after visual assessment, plasma total bilirubin (TB) was measured. Clinical factors positively associated with UCB bilirubin were ABO incompatibility, positive DAT, presence of maternal red cell antibodies, alarming visual assessment and significant hyperbilirubinemia in the first 6 days of life. UCB bilirubin performed clinically well with an area under the receiver-operating characteristic curve (AUC) of 0.82 (95 % CI 0.80-0.84). The combined UCB bilirubin, DAT, and blood group analysis outperformed results of these parameters considered separately to detect significant hyperbilirubinemia and correlated exponentially with hyperbilirubinemia post-test probability. Post-test probabilities for neonatal hyperbilirubinemia can be calculated using exponential functions defined by UCB bilirubin, DAT, and ABO compatibility results. • The diagnostic value of the triad umbilical cord blood bilirubin measurement, direct antiglobulin testing and blood group analysis for neonatal hyperbilirubinemia remains unclear in literature. • Currently no guideline recommends screening for hyperbilirubinemia using umbilical cord blood. What is New: • Post-test probability for hyperbilirubinemia correlated exponentially with umbilical cord blood bilirubin in different risk groups defined by direct antiglobulin test and ABO blood group compatibility results. • Exponential functions can be used to calculate hyperbilirubinemia probability.

Relationship between newborn craniotabes and vitamin D status.

OBJECTIVE:In recent studies, vitamin D deficiency during pregnancy and early infancy has been reported to predispose children to many chronic diseases, except those of the skeletal system. The aim of this study was to investigate whether craniotabes in otherwise healthy newborns is physiological, its relationship to vitamin D deficiency and whether or not it requires treatment.METHODS:A total of 150 healthy newborns with a weight of over 2000 g were included. Newborns were divided into two groups during postnatal discharge (1-3.’s day): those with and without craniotabes. The 25-hydroxy (OH) vitamin D levels of the newborns’ mothers were measured, and all infants were re-evaluated for craniotabes, as well as tested to determine levels of serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathyroid hormone (PTH) and 25(OH) vitamin D, urine calcium and creatinine.RESULTS:Craniotabes was present in 45 (30%) of newborns enrolled in the study. Craniotabes of the newborns born during the winter months was significantly higher. PTH level was significantly higher in 1-month-old newborns with craniotabes than those without craniotabes. No relationship was observed between diet and craniotabes, but in exclusively breastfed infants, vitamin D level was statistically significantly lower. No statistically significant difference was found in the occurrence of craniotabes in newborns with or without vitamin D support.CONCLUSION:The relationship between newborn craniotabes and maternal vitamin D deficiency is not clear. However, the present study illustrates that maternal vitamin D deficiency is still a major problem. Therefore, measures to prevent maternal vitamin D deficiency should be strengthened.

The Duration of Hospitalization and Readmission Rate of Low Birth Weight Infants in a Tertiary Referral Hospital in Isfahan, Iran

Background: Currently, the number of premature deliveries has been increasing, resulting in early postnatal discharge due to shortage of beds in the neonatal intensive care units (NICU). Methods: This descriptive-analytical study was conducted through investigating the premature infants’ files for gestational age (GA), birth weight (BW) and duration of the first hospitalization. Furthermore, the readmission rate during the first year of life and their causes were studied. Results: Overall, 495 infants were enrolled in this study. The range of GA and BW of infants who were admitted to NICU were 24-36 weeks and 470 - 2500 g, respectively. A total of 172 (34.74%) infants had a BW of less than 1500 g (VLBW), and 144 of them (29.09%) were severely premature (GA of between 24-31 weeks). The median (range) time of hospitalization in VLBW infants was 22 (1-75). Moreover, 76 (15.3%) infants were re-hospitalized during the first year of life, and 32 (6.4%) infants were readmitted during the first three months of life. The four most common causes of re-hospitalization during the first year of life were as follows: pneumonia (32.89%), icter (17.10%), treatment of retinopathy of prematurity (10.52%) and sepsis (9.20%). Conclusion: Hospital policies are changing due to the high rate of preterm births and lack of neonatal beds. The results of this study suggested that premature neonates, who are able to regulate body temperature at room temperature, and gain weight by oral feeding with no recent apnoea or bradycardia, could be discharged regardless of their gestational age and body weight.

Timing of diagnosis affects mortality in critical congenital heart disease

ObjectiveScreening for critical congenital heart disease (CHD) with prenatal ultrasound or postnatal pulse oximetry has the potential to improve outcome. To guide screening recommendations, this study aimed to identify the...

Postpartum SMS reminders to women who have experienced gestational diabetes to test for Type2 diabetes: the DIAMIND randomized trial.

This parallel group randomized controlled trial assessed whether an SMS reminder system for women, after gestational diabetes, would increase their attendance for an oral glucose tolerance test (OGTT) by sixmonths postpartum. Women were eligible for inclusion if they were diagnosed with gestational diabetes in their recent pregnancy, had a mobile phone and normal blood glucose profile prior to postnatal discharge from the Women's and Children's Hospital, Adelaide. A computer-generated random number sequence and telephone randomization were used. Two hundred and seventy-six women were randomized. Women in the six-week group (n=140) were sent a text reminder to attend for an OGTT at six weeks postpartum, with further reminders at three and sixmonths if required. Women in the control group (n=136) received one text reminder at sixmonths postpartum. Blinding was not feasible. The primary outcome was OGTT attendance within sixmonths postpartum. Women in the six-week group did not increase their attendance for an OGTT within sixmonths postpartum compared with women in the control group, 104 (77.6% of 134) versus 103 (76.8% of 134), relative risk (RR) 1.01, 95% confidence interval (CI) 0.89-1.15. The SMS reminder system did not increase postpartum OGTT, fasting plasma glucose or HbA1c completion, although high rates of test completion were measured in both groups. Further research is required into factors influencing attendance for postpartum testing from the perspective of women, and into optimal counselling relating to Type2 diabetes risk in the postpartum period for increasing postpartum glucose testing rates.

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

Backgrounda move towards earlier postnatal discharge raises the challenge of finding new ways to support families when they are discharged early after childbirth. Aimto explore how postnatal parents experienced the use of telemedicine following early discharge from hospital (i.e. 24 hours after childbirth) by investigating if they consider that their postnatal needs are met, and whether or not they experience a sense of security and parental self-efficacy. Designintervention followed by a qualitative interview study. The intervention took place on a postnatal ward with approximately 1000 births a year. An app including chat, a knowledgebase and automated messages was trialled between postnatal parents at home and the hospital. Parents had access to the app for seven days after discharge. Population42 new mothers were recruited from the postnatal ward in accordance with the inclusion criteria (i.e. discharged within 24 hours of childbirth). Both parents were invited for interview. Methods42 sets of parents participated in the trial, and 28 sets agreed to be interviewed. Interviews (n=28) were conducted with 27 mothers and 11 fathers. Parents were interviewed together in 10 cases, 17 mothers were interviewed alone, and one father was interviewed alone. The data analysis was inspired by systematic text condensation based on Giorgi׳s descriptive phenomenological method. Findingsparents were confident in use of the app, and did not experience any barriers in contacting the nurses via asynchronous communication. Parents received timely information and guidance by communicating online, and felt that their follow-up support needs were met. Conclusionsparents viewed the app as a lifeline, and saw it as a means of informing and guiding them following early discharge from hospital after childbirth. As such, this app shows potential for enhancing self-efficacy and postnatal sense of security.

The Factors Affecting Neonatal Presentations to the Pediatric Emergency Department

BackgroundA pediatric emergency department (PED) may be utilized by neonates for nonurgent complaints. Various factors, such as primiparity, maternal age, early postnatal discharge, race, income, and maternal and paternal educational levels, have been reported to affect the acuity of neonatal emergency department utilization. ObjectiveTo determine the characteristics of PED visits by neonates (infants ≤ 28 days of age) and to evaluate the factors affecting the acuity of these visits. MethodsWe prospectively collected the data of neonates who were admitted to the PED of a tertiary university hospital within a 6-month period. Presenting problems were classified as acute if diagnostic tests were requested or the patient was hospitalized, unless the final diagnosis was “normal newborn.” ResultsOver this period, 28,389 children (0–18 years of age) visited the PED, of which 531 were newborns (1.9%). The mean age was 14.1 ± 8.3 days, with a slight predominance of males (57.3%). The chief complaints were jaundice (23.4%), irritability (9.5%), and vomiting (7.1%), and the most common diagnoses were normal newborn (33.9%), indirect hyperbilirubinemia (13.2%), and colic (5.8%). Acute visits were 55.7% of the total visits. Premature infants, infants of multiparous mothers, infants of older mothers (≥25 years), and physician-referred infants were more likely to present with acute problems (p values were 0.001, 0.013, 0.006, and <0.001, respectively). ConclusionThe results suggest that there may be a relationship between nonacute neonatal visits to a PED and insufficient knowledge of the caretaker on newborn care. Thus, more detailed education and early postnatal support programs regarding newborn care may help to decrease nonacute PED visits by neonates.

Nurses' experience of using an application to support new parents after early discharge: an intervention study.

Background. A development towards earlier postnatal discharge presents a challenge to find new ways to provide information and support to families. A possibility is the use of telemedicine. Objective. To explore how using an app in nursing practice affects the nurses' ability to offer support and information to postnatal mothers who are discharged early and their families. Design. Participatory design. An app with a chat, a knowledgebase, and automated messages was tried out between hospital and parents at home. Settings. The intervention took place on a postnatal ward with approximately 1,000 births a year. Participants. At the onset of the intervention, 17 nurses, all women, were working on the ward. At the end of the intervention, 16 nurses were employed, all women. Methods. Participant observation and two focus group interviews. The data analysis was inspired by systematic text condensation. Results. The nurses on the postnatal ward consider that the use of the app gives families easier access to timely information and support. Conclusions. The app gives the nurses the possibility to offer support and information to the parents being early discharged. The app is experienced as a lifeline that connects the homes of the new parents with the hospital.

Early post‐natal discharge and falling infant readmission rates

Journal of Paediatrics and Child HealthVolume 50, Issue 11 p. 929-929 Heads UpFree Access Early post-natal discharge and falling infant readmission rates First published: 06 November 2014 https://doi.org/10.1111/jpc.12748 edited by Craig Mellis (craig.mellis@sydney.edu.au) AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Here's some good news! Despite shorter lengths of stay for birth admissions, readmission rates during the first year of life are falling – at least in NSW. A large data-linkage study examined all live births in NSW and subsequent admission to hospital (either public or private) in the first year of life.1 Data were available for almost 800 000 live births from 2001 to 2009. Readmission rates fell from 18.4 per 100 births in 2001 to 16.5 in 2009, an absolute fall of 1.9 per 100 births or a relative decrease of 10.5% over that period. However, the current rate still means approximately one in six infants were readmitted in 2009. The most common reasons for admission were respiratory infections, viral infections and intestinal infections. Admission rates for jaundice and feeding difficulties increased over the study period. Multivariate analysis found the major independent factors associated with the fall in readmissions were increasing maternal age, decreasing rates of maternal smoking and shorter length of stay during the birth admission. Presumably, policy changes and programmes such as the Early Postnatal Discharge and home midwifery support programmes have also played a major role in reducing readmissions. These local data are valuable, because early post-natal discharge has been an area of controversy, with concerns infant readmission rates could increase as a direct consequence.2 References 1Lain SJ et al. MJA 2014; 201: 35– 39. PubMedWeb of Science®Google Scholar 2Brown S et al. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database Syst. Rev. 2002; (3): CD002958. Wiley Online LibraryGoogle Scholar Reviewer: Craig Mellis, University of Sydney, craig.mellis@sydney.edu.au Volume50, Issue11November 2014Pages 929-929 ReferencesRelatedInformation

What women want from women's reproductive health research: a qualitative study.

Researchers are being urged to involve patients in the design and conduct of studies in health care with limited insight at present into their needs, abilities or interests. This is particularly true in the field of reproductive health care where many conditions such as pregnancy, menopause and fertility problems involve women who are otherwise healthy. To ascertain the feasibility of involving patients and members of the public in research on women's reproductive health care (WRH). University and tertiary care hospital in north-east Scotland; 37 women aged 18-57. Four focus groups and one individual interview were audio-recorded and verbatim transcripts analysed thematically by two researchers using a grounded theory approach. Most participants were interested in WRH, but some participated to promote a health issue of special concern to them. Priorities for research reflected women's personal concerns: endometriosis, polycystic ovary syndrome, menopause, fertility risks of delaying parenthood and early post-natal discharge from hospital. Women were initially enthusiastic about getting involved in research on WRH at the design or delivery stage, but after discussion in focus groups, some questioned their ability to do so or the time available to commit to research. None of the respondents expected payment for any involvement, believing that the experience would be rewarding enough in itself. Involving patients and public in research would include different perspectives and priorities; however, recruiting for this purpose would be challenging.

Do families after early postnatal discharge need new ways to communicate with the hospital? A feasibilility study

Objectivethe length of the postnatal hospital stay in Denmark as well as globally has been radically reduced over the past 10–20 years and this raises the challenge of finding new ways of providing observation and support to families discharged early, that they otherwise would be provided as inpatients.Aim: this study is to identify the nursing support needs of new parents and their infants during the first seven days post partum, by drawing on the experiences of all stakeholders' in early postnatal discharge from hospital, and thereby gaining new knowledge to investigate further whether telemedicine is a viable option in providing the required support. Designthis article describes the first phase of a participatory design process. A qualitative approach guided the research process and the data analysis. Data were collected from participant observation, qualitative interviews with the new parents, focus groups interviews and a workshop attended by the new parents and health-care professionals. Participants and settingthe total number of participants in this study was 37; nineteen parents and 18 health-care professionals from one hospital and three municipalities in Denmark. Findingsthe investigation findings highlighted, amongst other aspects, the importance of individualised postnatal follow-up in which families have increased access to the health-care professionals and are provided with timely information tailored to their specific needs. Key conclusions and implications for practicethe present study underscored that the families experiencing early discharge were not provided with seamless individualised follow-up support. They requested more availability from the health-care system to respond to their concerns and questions during the postnatal period. They experienced a barrier in attempting to contact health-care professionals following hospital discharge and they asked for new ways to communicate that would eliminate that barrier and meet their needs for more individualised and timely information and guidance.

The DIAMIND study: postpartum SMS reminders to women who have had gestational diabetes mellitus to test for type 2 diabetes: a randomised controlled trial – study protocol

BackgroundPostpartum follow up of women who have been found to have gestational diabetes during pregnancy is essential because of the strong association of gestational diabetes with subsequent type 2 diabetes. Postal reminders have been shown to increase significantly attendance for oral glucose tolerance testing postpartum. It is possible that a short message service (text) reminder system may also be effective. This trial aims to assess whether a text message reminder system for women who have experienced gestational diabetes in their index pregnancy will increase attendance for oral glucose tolerance testing within six months after birth.Methods/DesignDesign: Single centre (Women’s and Children’s Hospital, South Australia), parallel group randomised controlled trial.Inclusion criteria: Women diagnosed with gestational diabetes in their index pregnancy (oral glucose tolerance test with fasting glucose ≥ 5.5 mmol/L and/or two hour glucose ≥ 7.8 mmol/L), with access to a mobile phone, whose capillary blood glucose profile measurements prior to postnatal discharge are all normal (fasting glucose < 6.0 mmol/L, postprandial glucoses < 8.0 mmol/L).Exclusion criteria: Pregestational diabetes mellitus, triplet/higher order multiple birth or stillbirth in the index pregnancy, requirement for interpreter.Trial entry and randomisation: Allocation to intervention will be undertaken using a telephone randomisation service (computer-generated random number sequence generation, with balanced variable blocks, and stratification by insulin requirement).Study groups: Women in the intervention group will receive a text reminder to attend for an oral glucose tolerance test at 6 weeks postpartum, with further reminders at 3 months and 6 months if they do not respond to indicate test completion. Women in the control group will receive a single text message reminder at 6 months postpartum.Blinding: Baseline data collection will be undertaken blinded. Blinding of participants and blinded collection of primary outcome data will not be possible for this study.Primary study outcome: Attendance for the oral glucose tolerance test within 6 months postpartum.Sample size: 276 subjects will be required to show an 18% absolute increase in the rate of attendance (α=0.05 two tailed, β=80%, 5% loss to follow up) from 37% to 55% in the intervention group.DiscussionGiven the heightened risk of impaired glucose tolerance and type 2 diabetes in women who have had gestational diabetes, ensuring the highest possible rate of attendance for postpartum glucose tolerance testing, so that early diagnosis and intervention can occur, is important. A text message reminder system may prove to be an effective method for achieving improved attendance for such testing. This randomised controlled trial will assess whether such a system will increase rates of attendance for postpartum oral glucose tolerance testing in women who have experienced gestational diabetes.Trial RegistrationAustralian New Zealand Clinical Trials Registry - ACTRN12612000621819

Neonatal visits to the pediatric emergency center and its implications on postnatal discharge practices in Qatar

Background:An early discharge from postnatal policy has been practiced at Women's Hospital, Hamad Medical Corporation.Aim:This observational cohort study was conducted to evaluate the effect of early postnatal discharge practice on neonatal morbidity in the State of Qatar.Setting and Design:This is a data-based cohort study. All neonates ≤28 days visiting the Pediatric Emergency Centers (PEC) were evaluated for the need for re-hospitalization, referral for clinic appointments, or observation at the PEC setting.Materials and Methods:Differences in outcome rates were compared in neonates who visited in the first 24 hours postnatal discharge (2-3 days of life) and those who visited after the third day of life.Statistical Analysis:Crude differences in incidence rate assessed by χ2 or Fisher exact test were applicable.Results:Of 3528 PEC visits for 1915 neonates, 1.7% required admission (3.1% of neonates), 8.4% were observed, 1.1% were referred to a clinic, and the remaining were discharged home. There was no significant difference in re-hospitalization rates of neonates visiting PEC in the first 3 days and those visiting at a later age (OR 0.78, 95% CL 0.19-3.23, P=1). However, early presentations to PEC was more likely to result in periods of observation (OR 1.88, 95% CL 1.17-3.04, P=0.01), or clinic referral (OR 4.96, 95% CL 2.16-11.38, P=0.001) when compared to older neonates. Moreover, those who presented early were significantly more likely to revisit any of the PECs with in the 28 days period (OR 3.20, 95% CL 2.17-4.97, P<0.0001).Conclusion:These results clearly demonstrate the need for a structured early post-discharge follow-up service that addresses the needs of all neonates and their families. The results, however, do not provide sufficient evidence that delaying postnatal discharges for apparently healthy neonates will provide significant health benefits to these neonates and their families.

How participatory action research supported improvements to the postnatal discharge summary system used for remote dwelling Aboriginal mothers and infants in the Top End of Australia

This article describes and analyses the participatory action research (PAR) process used by researchers working with policy leaders and clinicians to facilitate health service improvement around postnatal discharge planning processes for remote-dwelling Aboriginal women and their newborn infants. The research presented here was a sub-study of a larger health system improvement investigation. Stringer’s (2007) working principles of PAR – participation, relationships, inclusion and communication – were used by researchers as a framework to describe a process of engagement for the research. Application of these principles prompted changes to the discharge planning process within the health system. The improvements included: redesign of discharge paperwork; nomination of a designated health professional at the remote community to receive summaries; training for hospital staff in the computer application that generated the discharge summaries; and the development of a length of stay and discharge policy. Hospital service providers have formed a working group that meets to discuss issues around the discharge process and work continues to review and strengthen the discharge process. Hospital management reported that the changes resulted in improvements, with more likelihood that correct information is being received by the appropriate health professional in a timely manner.