Risk Factors and Reasons for Discharge Against Medical Advice for Newborns With Neonatal Surgical Diseases: A Preliminary Study From a Tertiary Care Hospital in Beijing, China

Shen, Yang; Cai, Siyu; Liao, Junmin; Peng, Xiaoxia; Huang, Jinshi

doi:10.3389/fped.2020.576270

Cited by 5 publications

(10 citation statements)

References 12 publications

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“…This finding is similar to the 22.24% and 25.4% reported from NICUs in India [ 12 , 13 ] but higher than Nepal (18%) [ 1 ] and Nigeria (11.2%) [ 3 ]. Emergency admission and admission to the neonatal intensive care unit itself was reported as a significant independent risk factor for DAMA [ 2 , 8 ]. Prejudiced decision making by the family members contributed to increase DAMA among neonates [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…DAMA is a major challenge for hospital treatment teams and it is practically common in all medical facilities and difficult to eliminate leading to unpredictable complications [ 2 ]. PNA, sepsis and prematurity without complications were the most common diagnoses in DAMA neonates.…”

Section: Discussionmentioning

confidence: 99%

“…The neonatal period, a child’s first month of life, is the most critical time for survival [ 2 ]. Self-discharge poses a unique challenge to neonates, as they not only have emotional and cognitive immaturity but also have no legal rights to decide for themselves [ 1 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Discharge against medical advice in Special Care Newborn Unit in Chattogram, Bangladesh: Prevalence, causes and predictors

et al. 2023

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Introduction Discharge against medical advice (DAMA) is an unexpected event for patients and healthcare personnel. The study aimed to assess the prevalence of DAMA in neonates along with characteristics of neonates who got DAMA and, causes and predictors of DAMA. Methods and findings This case-control study was carried out in Special Care Newborn Unit (SCANU) at Chittagong Medical College Hospital from July 2017 to December 2017. Clinical and demographic characteristics of neonates with DAMA were compared with that of discharged neonates. The causes of DAMA were identified by a semi-structured questionnaire. Predictors of DAMA were determined using a logistic regression model with a 95% confidence interval. A total of 6167 neonates were admitted and 1588 got DAMA. Most of the DAMA neonates were male (61.3%), term (74.7%), outborn (69.8%), delivered vaginally (65.7%), and had standard weight at admission (54.3%). A significant relationship (p < 0.001) was found between the variables of residence, place of delivery, mode of delivery, gestational age, weight at admission, and day and time of outcome with the type of discharge. False perceptions of wellbeing (28.7%), inadequate facilities for mothers (14.5%), and financial problems (14.1%) were the prevalent causes behind DAMA. Predictors of DAMA were preterm gestation (AOR 1.3, 95% CI 1.07–1.7, p = 0.013), vaginal delivery (AOR 1.56, 95% CI 1.31–1.86, p < 0.001), timing of outcome after office hours (AOR 477.15, 95% CI 236–964.6, p < 0.001), and weekends (AOR 2.55, 95% CI 2.06–3.17, p < 0.001). Neonates suffering from sepsis (AOR 1.4, 95% CI 1.1–1.7, p< 0.001), Respiratory Distress Syndrome (AOR 3.1, 95% CI 1.9–5.2, p< 0.001), prematurity without other complications (AOR 2.1, 95% CI 1.45–3.1, p < 0.001) or who were referred from north-western districts (AOR 1.48, 95% CI 1.13–1.95, p = 0.004) had higher odds for DAMA. Conclusions Identification of predictors and reasons behind DAMA may provide opportunities to improve the hospital environment and service related issues so that such vulnerable neonates can complete their treatment. We should ensure better communication with parents, provide provision for mothers’ corner, especially for outborn neonates, maintain a standard ratio of neonates and healthcare providers, and adopt specific DAMA policy by the hospital authority.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Discharge against medical advice in Special Care Newborn Unit in Chattogram, Bangladesh: Prevalence, causes and predictors

et al. 2023

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“…Studying the local neonatal disease spectrum is important for the prevention and treatment of neonatal disease. However, to date, reports have mainly focused on the developed areas of China, such as Beijing (5), Hefei (6), Changsha (7), and Shanghai (8). These studies found that the types, order and mortality rate of diseases change over time, and reported that gestational age (9)(10)(11)(12)(13) and birth weight (14)(15)(16) are significantly correlated with neonatal diseases.…”

Section: Introductionmentioning

confidence: 99%

The Disease Spectrum and Influencing Factors of NICU in Xiangxi, Underdeveloped Area of China: A 9-Year Retrospective Study

et al. 2022

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ObjectiveInvestigation of the basic conditions and disease spectrum in neonatal intensive care unit (NICU) from 2012 to 2020, in the underdeveloped area of Xiangxi, China.MethodsAll newborns (N = 16,094) admitted to the NICU of a hospital in the Xiangxi area from 2012 to 2020 were selected for the retrospective study.ResultsThe average male/female ratio was 1.43:1, with 9,482 males and 6,612 females admitted to the NICU. The sample comprised 41.02% premature infants, and 56.52% had been delivered via cesarean delivery (CD). The most prevalent diseases diagnosed in the NICU were jaundice (22.01%), respiratory (18.45%) and neurological diseases (17.54%). Over the 9-year study window, the prevalence of jaundice and cardiovascular diseases increased, while respiratory and neurological diseases became less frequent. The prevalence of the remaining diseases remained unchanged. Prevalence of neonatal diseases is influenced by gender, patient sources, delivery methods, gestational age and birth weight (P < 0.05). The prevalence of neonatal diseases was significantly higher in males, infants born via CD, and in infants of lower gestational age and birth weight.ConclusionThe study contributes in-depth information about infant characteristics in an NICU in an undeveloped region of China. In the past 9 years, the average proportion of premature infants in the NICU decreased to 37.38% in 2020, but this figure remains higher than the Chinese national average of 26.2%. Similarly, the CD rate is higher than the Chinese average. The spectrum of neonatal diseases in the NICU in Xiangxi area is drawn, included jaundice, respiratory and neurological diseases, primarily. Through statistical analysis, it is found that the types and prevalence of neonatal diseases are closely related to different gender, gestational age, patient sources, delivery methods, and birth weight (P < 0.05). Newborns of specific gestational age, birth weight and delivery method should be considered “at-risk” and targeted in the formulation of preventive measures. There is a great need to improve the diagnosis and treatment of neonatal diseases—and perinatal health care in general—to ensure improved outcomes for newborns admitted to NICUs in underdeveloped regions.

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“…Infants born at less than 32 weeks (very preterm infants, VPIs) account for about 15-16% of all preterm births, with the highest mortality and morbidity rates (1,2). In China and many other middle-or low-income countries, it has been reported that discharge against medical advice (DAMA) contributes significantly to the high mortality and morbidity of VPIs (3)(4)(5)(6)(7)(8). DAMA refers to a situation wherein parents terminate treatment before the treating physicians recommend discharge.…”

Section: Introductionmentioning

confidence: 99%

Discharge against medical advice among infants with 24–31 weeks’ gestation admitted to Chinese neonatal intensive care units: A multicenter cohort study

Xiu

Bai

et al. 2022

Front. Pediatr.

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BackgroundPrevious studies demonstrated high rates of discharge against medical advice (DAMA) among very preterm infants (VPIs) in China.ObjectivesThe aim of this study was to investigate the concurrent incidence, variation, and predictors of DAMA, along with the effect of DAMA on mortality of VPIs in China using data from the Chinese Neonatal Network (CHNN).MethodsAll infants born at 24–31 completed weeks’ gestation and admitted to 57 CHNN neonatal intensive care units (NICUs) in 2019 were included for this cohort study, excluding infants with major congenital anomalies. Patient information was prospectively collected using the CHNN database. Multivariable log-linear regression analysis was used to assess the association of perinatal factors and DAMA.ResultsA total of 9,442 infants born at 24–31 completed weeks’ gestation and admitted to 57 CHNN participating sites in 2019 were included in the study. Overall, 1,341 infants (14.2%) were discharged against medical advice. Rates of DAMA decreased with increasing gestational age (GA), and infants with lower GA were discharged earlier. DAMA infants had significantly higher rates of necrotizing enterocolitis, severe brain impairment, and bronchopulmonary dysplasia than non-DAMA infants. A total of 58.2% DAMA infants were predicted to die after discharge. The attributable risk percentage of mortality among DAMA infants was 92.4%. Younger maternal age, lower gestational age, small for gestational age, and Apgar score ≤3 at 5 min were independently associated with an increased risk of DAMA, while infants with antenatal steroids were less likely to be DAMA.ConclusionThe rate of DAMA in preterm infants between 24 and 31 weeks’ gestation remained high in China with a significant impact on the mortality rates. Continuous efforts to reduce DAMA would result in substantial improvement of outcomes for VPIs in China.

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Risk Factors and Reasons for Discharge Against Medical Advice for Newborns With Neonatal Surgical Diseases: A Preliminary Study From a Tertiary Care Hospital in Beijing, China

Cited by 5 publications

References 12 publications

Discharge against medical advice in Special Care Newborn Unit in Chattogram, Bangladesh: Prevalence, causes and predictors

Discharge against medical advice in Special Care Newborn Unit in Chattogram, Bangladesh: Prevalence, causes and predictors

The Disease Spectrum and Influencing Factors of NICU in Xiangxi, Underdeveloped Area of China: A 9-Year Retrospective Study

Discharge against medical advice among infants with 24–31 weeks’ gestation admitted to Chinese neonatal intensive care units: A multicenter cohort study

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