Reducing the length of hospitalisation for preterm infants has been suggested to have positive emotional and psychological benefits for the family (Laddem 1992) and for the infant's development (Casiro 1993). Randomised controlled trials have shown that 'early discharge' of physiologically stable preterm infants based on a set weight criterion is safe and cost effective (Cruz 1997; Casiro 1993; Brooten 1986; Lefebvre 1982). However, to be eligible for inclusion in these studies the infants had to be gaining weight satisfactorily on full sucking feeds.
The discharge of physiologically stable preterm infants who still need
gavage feeds has been reported (Evans 1988; Wakefield 1994; Evanochko 1996; Swanson
1997). This model of care is based on the premise that graduation to
full sucking feeds can be undertaken successfully at home with health care
support. The potential benefits of this model of care are that by uniting
the family earlier there may be a positive impact on the infant's development;
and there would also be a reduction in costs to the health service and family.
The potential disadvantages arise from the possibility for an increased
burden on the family with this higher level of care, and the possible complications
associated with gavage feeding, for example growth failure and aspiration
pneumonia.
Descriptions of home gavage feeding programs all provide some form of
follow-up until gavage feeding is no longer required and there is adequate
weight gain. The types of health care support described include outpatient
clinic visits with hospital and/or parent-initiated telephone calls (Evans 1988; Evanochko
1996); home visits as considered necessary by the nurse or as requested
by the mother; health caretaker-initiated telephone calls; and 24 hour emergency
phone contact for parents (Wakefield 1994;
Swanson 1997).
All studies reported that early discharge with home gavage feeding for stable preterm infants was safe in terms of adequate weight gain, and no infants required readmission (Evans 1988; Wakefield 1994; Evanochko 1996; Swanson 1997). Swanson 1997 reported a reduction in hospital stay of 9.3 days from the birth weight category average. Anecdotal responses from parents about the home gavage feeding programs were positive (Evans 1988; Wakefield 1994; Evanochko 1996; Swanson 1997). The studies, however, were small and uncontrolled, with poorly defined outcomes.
It is important that the safety of early discharge with home gavage feeding for stable preterm infants is established. It is also important to establish the effect on the family of this increased level of care. The conduct of a systematic review to assess current evidence is warranted.
Sub-group analyses were planned to determine if safety and efficacy outcomes are altered by the type of support received (outpatient visits versus home support) or the maturity of the infants (gestational age <= 28 weeks at birth or birth weight <=1000 grams).
Primary safety outcomes:
2. Re-admission
2.1 rehospitalisation during the period of home gavage feeding
2.2 rehospitalisation (excluding home gavage period) in the first year
post discharge
3. Adverse events
3.1 milk aspiration - on radiologic assessment
3.2 infection during period of gavage feeding
3.3 death within the first year post discharge
Secondary outcomes:
1. Satisfaction
1.1 Parental satisfaction as measured by self report, including assessment
of key elements of such programs, e.g. education
2. Cost
2.1 Cost comparison from trial entry to discharge from hospital or home
support for both the hospital and family. For the home gavage group: cost
of home support (home visits, phone calls). For those discharged on full
sucking feeds: cost of extra hospital stay, cost to parents of visiting
- e.g. travel costs).
3. Health service use
3.1 Other health service use post discharge from hospital or home support
(includes visits to physician, outpatient clinics or emergency department)
See: Cochrane Neonatal Group search strategy. The standard search strategy of the Cochrane Neonatal Review Group was used.
Literature searches of the Cochrane Central Register of Controlled Trials
(CENTRAL, The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to April Week
1 2003), CINAHL (1982 to April Week 1 2003) and EMBASE (1980 to 2003 Week
15) databases were undertaken.
The free text terms used were 'early discharge', 'hospital in the home',
'random$', 'gavage', 'gavage feed$', 'tube feed$'. The MESH terms used included:
infant low birth weight, infant premature, infant premature diseases, patient
discharge, home care services, home nursing, length of stay, enteral nutrition,
randomised controlled trials, random allocation, double blind method, single-blind
method, clinical trials. The search was not restricted by language.
Selection of studies for inclusion
Studies were excluded if it was apparent from the abstract that
they did not meet the inclusion criteria as assessed by one reviewer (C
Collins). Where there was uncertainty about inclusion of the study, the
full text was retrieved. Two reviewers (C Collins, M Makrides) independently
assessed the full text articles for inclusion. If there was disagreement
between reviewers about the studies to be included that could not be resolved
by discussion, assistance from the third reviewer was sought.
Assessment of methodological quality
Once inclusion of trials had been agreed, the methodology of the trial
was assessed. The data were extracted onto hard copy data sheets. Data extraction
and quality assessment were made by C Collins and M Makrides. The standard
methods of the Neonatal Review Group were used to assess the methodological
quality of the included trials. These included assessing the trial for
blinding of randomisation, blinding of intervention, completeness of follow
up and blinding of outcome measurement.
Additional information was requested from Gibson 1998 for outcome data on the sub-group of infants discharged home gavage feeding. Additional information was also requested from Ortenstrand 1999 on: breast feeding outcomes; blinding of outcome assessment; length of hospitalisation; health service use. Verification of the inclusion criterion concerning feeding status was requested for three trials (Davies 1979; Dillard 1973; Puerto 1993).
Analysis
Analyses for treatment effect were conducted on an intention-to-treat
basis. Relative risk and risk difference with 95% confidence intervals
were calculated for dichotomous data. Mean difference with 95% confidence
intervals were used for outcomes measured on a continuous scale.
Gibson 1998 conducted a randomised controlled trial of a home supported early discharge program. Infants were eligible for the study if birth weight was less than or equal to 1800 grams and gestational age was <36 weeks at birth. Exclusion criteria included infants with congential abnormalities, severe apnoea, neurological impairment, feeding intolerance, or an unwilling or incapable caregiver, unsafe home environment or home care services inaccessible. Infants in the experimental group were discharged home at approximately 1800 grams if certain clinical criteria were met, one of which was "infant tolerating full feedings, either via gavage or nipple" (p S18). The control group were discharged home according to routine hospital policy including the requirement to be on full sucking feeds. The authors have not reported the proportion of infants that received home gavage feeds. In a published abstract describing the first 50 infants enrolled in their study (Gibson 1996) five infants (10%) were discharged home requiring gavage feeds. The final sample size for the study was 100 infants (Gibson 1998); if the trend for proportion discharged home on gavage feeds continued then ten infants would have been so. It may be possible to include data from this study if the authors have separate subgroup analyses for the outcomes of those who were discharged home on gavage feeding. Data from this study will be considered for inclusion when available from the authors.
In the study of Ortenstrand 1999, the majority of infants in the experimental group (80%) were discharged home still requiring gavage feeds (n=36/45). The inclusion criteria for this systematic review was 'early discharge home with gavage feeds and health care support versus later discharge home when full sucking feeds are attained'. Given the difficulty in locating studies specifically designed to assess home gavage feeding we have decided to include this study, even though 20% (9/45) of the infants in the experimental group did not receive home gavage feeds. The nine infants who did not receive home gavage feeds were discharged to the program and received home visits. They were discharged from the program when the ordinary criteria for hospital discharge were met, i.e. clinically well and gaining weight satisfactorily on full sucking feeds. These nine infants were included in the analysis for this systematic review.
For the purposes of this review the experimental group will be referred
to as the home gavage program.
This review, therefore, includes one quasi-randomised controlled
clinical trial (Ortenstrand 1999) from
which there are two publications.
Participants
This single centre Swedish study involved 88 infants from 75 families
(45 infants/40 families - experimental, 43 infants/35 families - control).
Participants were preterm infants with a mean gestational age at birth
of 31.4 weeks (SD 2.8) in the experimental group and 32 weeks (SD 2.3) in
the control. 70% (23/40) of mothers in the experimental group were primiparous
and 60% (21/35) in the control group. There were five pairs of twins in
the experimental group (10/45, 22%) and eight in the control (16/43, 37%).
Interventions
This trial compared early discharge with home visits by a registered nurse
for infants still requiring special care (mainly gavage feeds) with standard
care (discharge home when clinically well and gaining weight satisfactorily
on full sucking feeds). The large majority of the infants in the early discharge
group were discharged home still requiring gavage feeds (36/45, 80%). Infants
were discharged from the home program when the ordinary criteria for hospital
discharge were met, i.e. clinically well and gaining weight satisfactorily
on full sucking feeds.
Study entry occurred when infants met the inclusion criteria listed in the table of included studies. On study entry, infants in the experimental group (allocated to the home program) had a mean postmenstrual age of 35.9 weeks, SD 1.6 and infants in the control group (who remained in hospital) had a mean postmenstrual age of 35.6 weeks, SD 1.2.
Outcome measures and results
The end of the intervention was discharge from the home gavage program
for the experimental group and discharge from hospital for the control group.
There was no significant difference in postmenstrual age at the end of study
intervention (experimental 38.7 weeks, control 38.6 weeks). The trial measured
breast feeding outcomes, weight gain, rehospitalisation, infection (clinical
signs), health problems, medications, home visits, telephone calls, visits
to neonatal ward, travelling time for nurse, health service use during first
year post discharge, confidence in handling baby, experiences relating to
care, experiences relating to infants' health and parental anxiety.
For further details see Table: Characteristics of Included Studies.
Randomisation: After discussion and consultation it was agreed to accept the Ortenstrand 1999 study as a quasi-randomised controlled trial. The nursery in the trial had two separate rooms with separate teams of nursing staff, the rooms were randomly designated as experimental or control. Allocation of infants to the control or experimental group was based on bed availability. The authors report that the unit was constantly busy and the opportunity to choose between the rooms was "almost never an option" (Ortenstrand 1999, p 1025). To minimise the potential for the hospital nursing teams to affect outcomes the designation of experimental room and control room was changed after an eight month period. Due to the potential for selection bias the blinding of randomisation was classified inadequate.
Blinding of treatment: not possible
Exclusions after randomisation: 7% for primary outcomes, 14% for secondary outcomes
Blinding of outcome assessment: yes
Primary outcomes
1. Feeding and growth
1.1 Days to reach full sucking feeds
Not reported.
1.2 Breast feeding (outcome tables 01 and 02)
Breast feeding outcome data were reported only for those who completed
the one year follow up (experimental group n=41, control group n=41). There
were no statistically significant differences between the experimental and
control groups in the proportion of infants who had stopped any (fully and
partially) breast feeding at any time points. By the time of discharge from
the home gavage program (experimental) or discharge from hospital (control),
2/41 of the home gavage group and 4/41 of the control group had stopped breast
feeding [RR for stopping breast feeding 0.50 (0.10 to 2.58)]. At three months
post discharge from the home gavage program (experimental) or post-discharge
from hospital (control), 8/41 of the home gavage group and 5/41 of the control
group had stopped breast feeding [RR 1.60 (0.57 to 4.48)]. At six months
post discharge from the home gavage program (experimental) or post-discharge
from hospital (control), 20/41 of the home gavage group and 12/41 of the control
group had stopped breast feeding [RR 1.67 (0.94 to 2.95)].
The outcome fully breast feeding was compared to a combined group of partially and not breast feeding. No significant differences were found in the proportion of infants not fully breast feeding in the home gavage group (experimental) compared with the control group at any time points. On discharge from the home gavage program (experimental) or discharge from hospital (control), 13/41 of the home gavage group and 10/41 of the control group were not fully breast feeding [RR for not fully breast feeding 1.30 (0.64 to 2.62)]. At three months post discharge from the home gavage program (experimental) or post-discharge from hospital (control), 8/41 of the home gavage group (experimental) and 6/42 of the control group were not fully breast feeding [RR 1.33 (0.51 to 3.50)]. At six months post discharge from the home gavage program (experimental) or post-discharge from hospital (control), 24/41 of the home gavage group (experimental) and 24/41 of the control group were not fully breast feeding [RR 1.00 (0.69 to 1.44)].
1.3 Weight gain (outcome table 03)
Weight gain was assessed from trial entry until discharge from the
home gavage program (experimental), and from trial entry to discharge from
hospital (control). No significant difference was detected in weight gain
[MD -1.10 g/day (-3.94 to 1.74)].
1.4 Length of hospitalisation (outcome table 04)
Infants in the home gavage program had a mean hospital stay that was 9.3
days shorter [MD -9.30 (-18.49 to -0.11)] than infants in the control group.
Infants in the home gavage program spent a mean of 19.6 days (SD 9.2 days)
on the home program.
1.5 Neurodevelopmental outcome at 12 months
Not assessed
2. Hospital re-admission (outcome table 05)
2.1 During period of home gavage feeding
8/45 infants were rehospitalised nine times during the home gavage program
(two infants for jaundice, two for blood transfusion, one for inguinal herniorrhaphy
and cryotherapy of retinopathy, one for observation prior to removal of apnoea
monitor, one for a skin condition and maternal anxiety, and one for respiratory
syncytial virus infection).
2.2 Re-admission within first 12 months post discharge from home gavage
program or from hospital.
Data on re-admissions post discharge from the home gavage program
or from hospital were reported only for those who completed the one year
follow up (experimental group n=41, control group n=41). There were no significant
differences between groups in the proportion of infants who had one or more
re-admissions during this period [RR 1.09 (0.54 to 2.18)]. 12/41 were readmitted
19 times in the home gavage group (median 0, range 0-5) and 11/41 infants
readmitted 22 times in the control group (median 0, range 0-7).
3. Adverse events (outcome table 06)
3.1 Milk aspiration on radiologic examination
Not reported.
3.2 Infection during period of home gavage and corresponding time in
hospital
Infants in the home gavage program had a lower risk of infection during
the home gavage period compared with the corresponding time in hospital
for the control group [RR 0.35 (0.17 to 0.69)]. In the home gavage group
6/45 infants developed a respiratory infection and 2/45 developed conjunctivitis;
in the control group 16/43 infants developed a respiratory infection and
six developed conjunctivitis. 4/45 infants in the home gavage group required
antibiotics, versus 10/43 in the control group. Infection was clinically
diagnosed without laboratory tests.
3.3 Death within the first 12 months post discharge
There was no significant difference in mortality between groups [RR 0.32
(0.01 to 7.62)]. One infant in the control group died of sudden infant death
syndrome during the first 12 months post discharge.
Secondary outcomes
1. Satisfaction and anxiety (outcome tables 07 and 08)
Ortenstrand 1999 measured parental confidence
in handling their infant by self report using Borg's category-ratio scale.
A higher score indicates greater confidence. There were no significant
differences in the score for confidence of either mothers [MD 0.40 (-0.66
to 1.46)] or fathers [MD 0.60 (-0.45 to 1.65)] in handling the baby at time
of discharge from the home gavage program (experimental) or the corresponding
time point, discharge from hospital (control).
The authors also measured parental feelings of preparedness to take responsibility for the care of their infant by self report using Borg's category-ratio scale. A higher score indicates greater preparedness. Mothers on discharge from the home gavage program scored higher in feeling prepared to take responsibility for the care of their baby compared with the control group, but this did not quite reach the conventional definition of statistical significance [MD 0.90 (-0.01 to 1.81)]. There were no significant differences in the scores of fathers between groups [MD 0.30 (-0.73 to 1.33)].
Parental anxiety was assessed using the State-Trait Inventory instrument. State anxiety is reported here because it refers to situational anxiety; a higher score indicates greater anxiety. There were no significant differences in maternal [MD -2.30 (-5.49 to 0.89)] or paternal [MD -1.80 (-4.60 to 1.00)] state anxiety scores at discharge from the home gavage program (experimental) compared with discharge from traditional hospital care (control).
2. Cost
Cost comparisons between groups were not undertaken in the included study
(Ortenstrand 1999).
3. Health Service Use (outcome table 09)
Data on health service use post discharge from the home gavage program
or from hospital were reported only for those who completed the one year
follow up (experimental group n=41, control group n=41). There were no significant differences in the year post-discharge
from home gavage program (experimental) or hospital (control) in the proportion
of infants with one or more non-elective visits to general practitioners
[RR 1.12 (0.68 to 1.83)], visits to paediatric outpatient clinics [RR 1.00
(0.58 to 1.72)] or visits to an emergency department [RR 0.88 (0.62 to 1.26)].
Planned sub-group analyses
Planned sub-group analyses according to type of post-discharge support
received or maturity of the infant could not be undertaken because the required
data were not available.
The included study made no cost comparisons from trial entry to discharge
from home support versus traditional hospital care, but did document the
amount of support provided during the home gavage period. This was as follows:
Although the single included study suggests that early discharge with home support of gavage feeding for stable preterm infants was a safe, manageable option for infant and family, and may even be beneficial, these results need to be interpreted with caution. The single trial in the review included a relatively small number of infants and was not adequately randomised. This may have resulted in a selection bias that makes it difficult to assess the true benefits and risks associated with the early discharge program. Nevertheless, the positive findings warrant further examination in high quality clinical trials with concealed allocation and adequate sample size.
The reviewers would like to thank Angela Falkenburg for reviewing the protocol from a parent's perspective; Karen Best for reviewing the protocol from a primary nurse perspective; Philippa Middleton (Cochrane Pregnancy and Childbirth Australian Reviewers' Group), David Henderson-Smart (Australasian regional coordinator for the Cochrane Neonatal Review Group) and Jane Bell (Research Officer, Australasian Coordinating Network for Neonatal Review Group) for assistance with this review.
| Study | Methods | Participants | Interventions | Outcomes | Notes | Allocation concealment |
| Ortenstrand 1999 | Type of trial - quasi randomised; blinding of randomisation - no (assigned on bed availability); blinding of treatment - no (not possible for participants or providers); complete follow up - 7% attrition for primary outcomes and 14% for secondary; blinding of outcome assessment - yes. | Single centre, Sweden; physiologically stable infants <37
weeks at birth with anticipated need for special care for at least another
week; no apnoeic episodes or apnoea medications; normal body temperature
while in open cot; parents of oxygen dependent infants able to handle equipment
and monitoring; parents assessed as capable of caring for infants; read, write
and understand Swedish. Excluded: triplets, quadruplets. Of 225 infants,
130 not eligible, 95 enrolled (48 infants - experimental, 47 infants - control),
7 infants/6 families withdrew from the study; 88 infants (75 families) analysed
(45 infants/40 families - experimental, 43 infants/35 families - control),
one year follow up 82 infants/70 families analysed (41 infants/37 families
- experimental, 41 infant/33 families - control); EDG: 1 family could not
be traced, 2 refused to participate; CG: SIDS x 1, one family refused to
participate. Intention to treat analysis undertaken. |
Experimental group: early discharge with domiciliary care home visits, gavage feeding at home by parents for 80% (36/45), continued on program until infants met control group criteria for discharge home as assessed by neonatologist. Domiciliary visits provided by experienced registered nurse, available Monday to Friday 8 am to 5 pm for scheduled and unscheduled home visits, available Monday to Friday out of hours by mobile phone, no home visits on weekends, parents could phone neonatal ward for help. Control group: Discharged home when clinically well, on full bottle &/or breast feeds and gaining weight satisfactorily. | Breast feeding (exclusive and any) on discharge from domiciliary care or hospital, duration of breast feeding to 12 months after discharge; weight gain during period of domiciliary care; length of hospitalisation, rehospitalisation during period of domiciliary care; rehospitalisation during first year (from end of domiciliary care period or discharge form hospital); infection during period of domiciliary care; death within first year; health service use during first year post discharge; anxiety and confidence in handling baby. | C |
| Study | Reason for exclusion |
| Bhargava 1980 | Inclusion criterion full sucking feeds |
| Brooten 1986 | Inclusion criterion full sucking feeds |
| Casiro 1993 | Inclusion criterion full sucking feeds |
| Charpak 1997 | Inclusion criterion full sucking feeds |
| Cruz 1997 | Inclusion criterion full sucking feeds |
| Davies 1979 | Inclusion criterion full sucking feeds |
| Dillard 1973 | Inclusion criterion full sucking feeds |
| Finello 1998 | Inclusion criterion full sucking feeds |
| Lefebvre 1982 | Inclusion criterion full sucking feeds |
| Puerto 1993 | Inclusion criterion full sucking feeds |
* Örtenstrand A, Waldenström U, Winbladh B. Early discharge of preterm infants needing limited special care, followed by domiciliary nursing care. Acta Paediatrica 1999;88:1024-30.
Örtenstrand A, Winbladh B, Nordström G, Waldenström U. Early discharge of preterm infants followed by domiciliary nursing care: parents' anxiety, assessment of infant health and breastfeeding. Acta Paediatrica 2001;90:1190-95.
Bhargava SK, Kumari S, Bawa S, Choudhury P, Lall UB. Early discharge of infants with weight of 1800 g. or less. Indian Pediatrics 1980;17:425-429.
Brooten 1986 {published data only}
Brooten D, Kumar S, Brown LP, Butts P, Finkler SA, Bakewell-Sachs S, Giggons A, Delivoria-Papadopoulos M. A randomized clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants. New England Journal of Medicine 1986;315:934-9.
Casiro 1993 {published data only}
Casiro OG, McKenzie ME, McFayden L, Shapiro C, Seshia MM, MacDonald N, Moffatt M, Cheang MS. Earlier discharge with community-based intervention for low birth weight infants: A randomized trial. Pediatrics 1993;92:128-34.
Charpak 1997 {published data only}
Charpak N, Ruiz-Peláez JG, Figueroa de C Z, Charpak Y. Kangaroo mother versus traditional care for newborn infants <=2000 grams: A randomized, controlled trial. Pediatrics 1997;100:682-688.
Cruz 1997 {published data only}
Cruz H, Guzman N, Rosales M, Bastidas J, Garcia J, Hurtado I, Rojas ME, Hodgman JE. Early hospital discharge of preterm very low birth weight infants. Journal of Perinatology 1997;17:29-32.
Davies 1979 {published and unpublished data}
Davies DP, Haxby V, Herbert S, McNeish AS. When should pre-term babies be sent home from neonatal units? The Lancet 1979;1:914-915.
Dillard 1973 {published and unpublished data}
Dillard RG, Korones SB. Lower discharge weight and shortened nursery stay for low-birth-weight infants. The New England Journal of Medicine 1973;288:131-33.
Finello 1998 {published data only}
Finello KM, Litton KM, deLemos R, Chan LS. Very low birth weight infants and their families during the first year of life: Comparisons of medical outcomes based on after care services. Journal of Perinatology 1998;18:365-71.
Lefebvre 1982 {published data only}
Lefebvre F, Veilleux A, Bard H. Early discharge of low birthweight infants. Archives of Disease in Childhood 1982;57:511-13.
Puerto 1993 {published and unpublished data}
Martin Peurto MJ, Gomez Castillo E, Pascual Patrao M, Pallas Alonso C. Alta precoz en recien nacidos de bajo peso. Experiencia de 5 anos [Early discharge of low-birth-weight neonates. 5-year experience]. Anales Espanoles de Pediatria 1993;38:20-4.
Gibson E, Medoff-Cooper B, Nuamah IF, Gerdes J, Kirkby S, Greenspan J, The Early Discharge Study Group. Accelerated discharge of low birth weight infants from neonatal intensive care: A randomized, controlled trial. Journal of Perinatology 1998;19:S17-S23.
* indicates the primary reference for the study
American Academy of Pediatrics. Hospital discharge of the high-risk neonate - proposed guidelines. Pediatrics 1998;102:411-17.
Clarke M, Oxman AD, editors. Cochrane Reviewer's Handbook 4.1.6 [updated January 2003]. In:The Cochrane Library, Issue 1, 2003. Oxford: Update Software. Updated quarterly, 2003.
Evanochko C, Jancs-Kelley S, Boyle R, Fox M, Molesky M, Byrne P. Facilitating early discharge from the NICU: the development of a home gavage program and neonatal outpatient clinic. Neonatal Network 1996;15:44.
Evans ID. Tubefeeding newborn babies at home. Journal of the Royal Army Medical Corps 1988;134:149-50.
Gibson E, Medoff-Cooper B, Kirkby S, Stavis R, Gerdes JS, Thompson JM, Greenspan JS. Early discharge of premature infants: a randomized controlled study. Pediatric Research 1996;39(4):Abstract 1242, p210A.
Labbok M, Krasovek K. Toward consistency in breastfeeding definitions. Studies in Family Planning 1990;21:226-30.
Laddem M, Damato E. Parenting and supportive programs. NAACOG's Clinical Issues in Perinatal and Women's Health Nursing 1992;3:174-87.
Swanson SC, Naber MM. Neonatal integrated home care: nursing without walls. Neonatal Network 1997;16:33-8.
Wakefield J, Ford L. Nasogastric tube feeding and early discharge. Paediatric Nursing 1994;6:18-19.
01.01 Stopped any breast feeding by different times (proportion of infants)
01.02 Stopped fully breast feeding at different times (proportion of infants)
01.03 Weight gain (g/day) on discharge from home gavage program (exp) or discharge from hospital (control)
01.04 Length of hospitalisation
01.05 Infants with one or more hospital re-admissions
01.06 Infants with one or more adverse events
01.08 Parental anxiety on discharge from home gavage program (exp) or discharge from hospital (control)
01.09 Health service use post discharge from home gavage program (exp) or from hospital (control)
| Comparison or outcome | Studies | Participants | Statistical method | Effect size |
|---|---|---|---|---|
| 01 Early discharge to home gavage program versus later discharge on full sucking feeds | ||||
| 01 Stopped any breast feeding by different times (proportion of infants) | RR (fixed), 95% CI | Subtotals only | ||
| 02 Stopped fully breast feeding at different times (proportion of infants) | RR (fixed), 95% CI | Subtotals only | ||
| 03 Weight gain (g/day) on discharge from home gavage program (exp) or discharge from hospital (control) | 1 | 88 | WMD (fixed), 95% CI | -1.10 [-3.94, 1.74] |
| 04 Length of hospitalisation | 1 | 88 | WMD (fixed), 95% CI | -9.30 [-18.49, -0.11] |
| 05 Infants with one or more hospital re-admissions | RR (fixed), 95% CI | Subtotals only | ||
| 06 Infants with one or more adverse events | RR (fixed), 95% CI | Subtotals only | ||
| 07 Parental satisfaction on discharge from home gavage program (exp) or discharge from hospital (control) | WMD (fixed), 95% CI | Subtotals only | ||
| 08 Parental anxiety on discharge from home gavage program (exp) or discharge from hospital (control) | WMD (fixed), 95% CI | Subtotals only | ||
| 09 Health service use post discharge from home gavage program (exp) or from hospital (control) | RR (fixed), 95% CI | Subtotals only | ||
Dr Andrew J McPhee
Deputy Head
Neonatal Medicine
Women's and Children's Hospital
72 King William Road
North Adelaide
South Australia AUSTRALIA
5006
Telephone 1: 61 8 8161 7631
E-mail: mcpheea@wch.sa.gov.au
| This review is published as a Cochrane review in
The Cochrane Library 2004, Issue 1, 2004 (see www.CochraneLibrary.net for
information). Cochrane reviews are regularly updated as new evidence emerges
and in response to comments and criticisms, and The Cochrane Library should
be consulted for the most recent version of the Review. |
