Parents' compliance with specific medical instructions in newborn discharge letters Academic Article uri icon


  • During the past two decades in the western world, the duration of stay of a healthy newborn in the nurseries has dramatically decreased from seven to 10 days to two to three days (1). As the length of the newborn stay for term infants decreased from 4.5 days in 1987 to 1988, to 2.5 days in 1993 to 1994 (2), the readmission rate per 1000 live births increased from two per 1000 live births to nearly eight per 1000 live births. Many of these readmissions were for jaundice or dehydration – conditions that may have been previously avoided when infants had longer hospital stays. In the ensuing decade, to circumvent potential deterioration in well-baby care in the immediate postpartum period, the nursery at Shaare Zedek Medical Center (Jerusalem, Israel) began providing parents with discharge letters detailing instructions for outpatient medical follow-up (eg, body weight and bilirubin levels). For some infants, discharge letters also detailed specific medical instructions for evaluation and follow-up of potentially significant perinatal and neonatal findings. Sample evaluation and follow-up instructions for the following were included: renal ultrasound for pelviectasis, hematocrit levels for anemia, cardiologist consultations for congenital anomalies, etc. A study by Dietz et al (3) revealed that up to one-third of parents may postpone compliance or be noncompliant with discharge instructions that contained medically relevant findings. Israel has reported better compliance with neonatal discharge instructions when the content of the discharge letter is reinforced by a nurse before discharge and both the nurse and the mother sign the letter (4). A study was suggested to validate the hypothesis that parents need verbal encouragement before leaving the hospital to comply with discharge recommendations. At the Shaare Zedek Medical Center, the standard practice at discharge is the following: the baby is examined by the neonatologist/paediatrician, the nurse ascertains that the discharge letter was given to the parent(s), the importance of the weight of the baby is reiterated by the nurse, the letter is then reviewed in detail by the nurse with the parent(s), the booklet for vaccination scheduling and appointments at the outpatient well-baby care clinics is provided, and then the nurse reminds the parent(s) of a checklist of concerns regarding the baby such as when to bathe, sleeping schedules, what to do in the event of fever, excessive crying and the reappearance of neonatal jaundice; finally, a further opportunity is given to the mother to meet with the breastfeeding specialist. Neither the staff/nurse nor the parent is required to affix a signature to the discharge letter. The purpose of the present retrospective study was to determine which specific medical instructions in the discharge letters are complied with and what factors influence parents’ compliance with specific medical instructions.

publication date

  • January 1, 2010