Linda P. Brown

A randomized clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants

To determine the safety, efficacy, and cost savings of early hospital discharge of very-low-birth-weight infants (less than or equal to 1500 g), we randomly assigned infants to one of two groups. Infants in the control group (n = 40) were discharged according to routine nursery criteria, which included a weight of about 2200 g. Those in the early-discharge group (n = 39) were discharged before they reached this weight if they met a standard set of conditions. For families of infants in the early-discharge group, instruction, counseling, home visits, and daily on-call availability of a hospital-based nurse specialist for 18 months were provided. Infants in the early-discharge group were discharged a mean of 11 days earlier, weighed 200 g less, and were two weeks younger at discharge than control infants. The mean hospital charge for the early-discharge group was 27 percent less than that for the control group (

Anxiety, depression, and hostility in mothers of preterm infants.

47,520 vs.

Nipple Shields for Preterm Infants: Effect on Milk Transfer and Duration of Breastfeeding

64,940; P less than 0.01), and the mean physicians charge was 22 percent less (

A randomized trial of early discharge and nurse specialist transitional follow-up care of high-risk childbearing women.

5,933 vs.

Breastfeeding Duration among Low Income Women

7,649; P less than 0.01). The mean cost of the home follow-up care in the early-discharge group was

Effects of clarification of support expectations in prenatal couples

576, yielding a net saving of

INITIATION AND FREQUENCY OF BREAST EXPRESSION IN BREASTFEEDING MOTHERS OF LBW AND VLBW INFANTS

18,560 for each infant. The two groups did not differ in the numbers of rehospitalizations and acute care visits, or in measures of physical and mental growth. We conclude that early discharge of very-low-birth-weight infants, with follow-up care in the home by a nurse specialist, is safe and cost effective.

THE BREASTFEEDING SUPPORT TEAM FOR LOW-INCOME, PREDOMINANTLY-MINORITY WOMEN: A PILOT INTERVENTION STUDY

Anxiety, depression, and hostility in 47 mothers of high-risk preterm infants were tested at the time of infant discharge and when the infant was 9 months old. Mothers of these high-risk preterms were significantly more anxious and depressed before their infant was discharged than when the infant was 9 months old. Before infant discharge, multiparas were significantly more depressed than primiparas. Additionally, mothers whose infants remained in the hospital longer than the mean of 51 days were significantly less depressed at infant discharge than were mothers whose infants had shorter hospital stays. Maternal anxiety, depression, and hostility did not differ based on marital status, maternal education, socioeconomic status, or maternal age at the time of infant discharge or when the infant was 9 months old.

Very low birth-weight infants: parental visiting and telephoning during initial infant hospitalization.

This study reports breastfeeding outcomes for 34 preterm infants whose mothers used ultra-thin silicone nipple shields to increase milk transfer. Mean milk transfer was compared for 2 consecutive breastfeedings without and with the nipple shield. Total duration of breastfeeding was calculated for a maximum of 365 days. Mean milk transfer was significantly greater for feedings with the nipple shield (18.4 ml vs. 3.9 ml), with all 34 infants consuming more milk with the nipple shield in place. Mean duration of nipple shield use was 32.5 days, and mean duration of breastfeeding was 169.4 days; no association between these variables was noted. The nipple shield was used for 24.3% of the total breastfeeding experience, with no significant association between the percentage of time the shield was used and total duration of breastfeeding. These findings are the first to indicate that nipple shield use increases milk intake without decreasing total duration of breastfeeding for preterm infants.

Functions of the CNS in early discharge and home followup of very low birthweight infants.

In a randomized clinical trial, quality of health care as reflected in patient outcomes and cost of health care was compared between two groups of high-risk childbearing women: women diagnosed with diabetes or hypertension in pregnancy. The control group (N = 52) was discharged routinely from the hospital. The intervention group (N = 44) was discharged early using a model of clinical nurse specialist transitional follow-up care. During pregnancy, the intervention group had significantly fewer rehospitalizations than the control group. For infants of diabetic women enrolled in the study during their pregnancy, low birth weight (< or = 2,500 g) was three times more prevalent in the control group (29%) than in the intervention group (8.3%). The postpartum hospital charges for the intervention group were also significantly less than for the control group. The mean total hospital charges for the intervention group were 44% less than for the control group. The mean cost of the clinical specialist follow-up care was 2% of the total hospital charges for the control group. A net savings of