Expert urges more care for early discharge babies

A LEADING consultant has called for expanded community care to prevent jaundice and weight loss in new babies discharged early from hospital.

Dr Winifred Gorman, a consultant neonatologist at the National Maternity Hospital at Holles Street in Dublin, said staff shortages at its neonatal unit and limited community support made care of early discharge babies very difficult.

The health problems of non-national women increased pressures on services, she said.

“The increasingly early discharge of mothers, combined with the increasing multiplicity of the potential problems that patients from many foreign countries have, has made appropriate care of the healthy infant extremely challenging,” Dr Gorman wrote in the hospital’s annual report 2003, published in Medicine Weekly.

“Babies who are discharged early are at risk of severe jaundice or severe weight loss if breastfeeding is not adequately established. Good community services are essential if catastrophes are to be avoided,” she added.

While the NMH’s Early Transfer Home (ETH) Team provides an essential service in the areas which it serves, it was not possible for the team to see infants outside its catchment area, Dr Gorman said. Consequently, many of the discharges had no community support.

Clinical midwife manager and co-ordinator of external services at the Coombe Hospital, Claire Fleming, said mothers who availed of their ETH scheme were well catered for.

Ms Fleming said the mother remained a patient of the Coombe, with access to emergency room services, including out-of-hours emergency paediatric services, until the baby was six weeks old. Visiting midwives were equipped to test the baby for jaundice and the introduction of an on-the-spot jaundice test is under assessment. Just 0.2% of mothers and 0.36% of babies had to be re-admitted to the Coombe last year. Up to 100 early discharges occurred monthly.

However, at Holles St mothers outside the catchment area of its ETH programme, are placing extra demands on its neonatal unit when they present with an infant who has been discharged early. This demand could be reduced by expanding community care, Dr Gorman said. She described the general workload of the Neonatal Department as “huge” and said a fourth consultant neonatologist was vital to ensure the safety of the service.

The NMH Neonatal Department has submitted a development plan to the Department of Health setting out expected difficulties and staff requirements for the next five years, but no progress has been made on sanctioning extra posts.