Taking a newborn place of abode is...

Taking a newborn place of abode is an exciting and anxious time. This may be an opportunity for physicians to educate patients, or it may be a time when the mother is tired and the family is too distracted to benefit from physician counseling. In this issue of American Family Physician, Dr Langan provides a list of topics for physicians to discuss with parents before their baby is discharged from the hospital. (1) His recommendations are similar to the American Academy of Pediatrics' policy forward discharging newborns from the hospital. (2) Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (3) lists many more topics, however, including further safety education (eg safe cribs and playpens, bathwater temperature, siblings and especially likeds handwashing, gun safety) and provides an assessment of the family circle situation. Even this short list of topics constitutes a significant investment of time for discussion, and the wide variations in newborn discharge recommendations can be importunate Physicians may ask, is this the right information? Is my time with the patient productive? What do I know about the evidence that supports these recommendations?

A fresh review (4) of preventive pediatric interventions revealed that the evidence is scant at best. The limited evidence exhibits that counseling can change a certain number of risk behaviors associated with childhood injury and can improve car seat use; counseling patients onward smoking cessation has a small on the other hand real effect; and multifaceted breastfeeding-support programs help breastfeeding continuance. Regarding other items mentioned in Dr Langan's article, evidence is lacking that these orderly dispositions are beneficial or improve outcomes

smooth if good evidence existed to support the numerous recommendations in succession parent counseling, many questions would remain. Who should provide this information and how? It might be provided through the nurse; a patient educator; or end audio, video, or written materials or interactive computer programs. Important information may ne to be delivered using more than single approach. Where and when should the counseling be provided? It could flash on the mind during prenatal care, during hospitalization, or just before discharge, and it could be delivered individually or in a form into groups setting. Should the information be given merely to the parent or to other possible caretakers? All of these questions warrant further investigation to clarify the most numerous effective way to deliver this information.

Evidence regarding newborn counseling is lacking, further physicians need guidance even when evidence is unavailable. High-quality guidelines and health policies explicitly describe the evidence when it is available and and nothing else rely on expert consensus when evidence is unavailable. Physicians can rely forward these guidelines for the best results In addition, checklists can help physicians remember to conceal all of the important topics with parents. (5)

The bottom line is that physicians should use guidelines and checklists that are based forward the best available evidence in such a manner that limited resources (especially time) can be used to implement effective services. Physicians should cautiously implement services that have unknown effectiveness.

REFERENCES

(1) Langan RC Discharge acts for healthy newborns. Am Fam Physician 2006;73:849-52 857-8

(2) The American Academy of Pediatrics Committee onward Fetus and Newborn. Hospital stay for healthy period of time newborns. Pediatrics 2004;113:1434-6.

(3) virid M, Palfrey J. Bright futures: guidelines for health supervision of infants, children, and adolescents. 2nd ed Arlington, Va.: National Center for Education in Maternal and Child Health, 2002

(4) Moyer VA, Butler M Gaps in the evidence for well-child care: a challenge to our profession. Pediatrics 2004;114:1511-21

(5) Schectman JM Schorling JB Nadkarni MM Lyman JA, Siadaty M Vos JD The result of physician feedback and an action checklist upon diabetes care measures. Am J M Qual 2004;19:207-13

Virginia A. Moyer MD MPH is professor of pediatrics and internal medicine at the University of Texas (UT) Medical instruct at Houston. She is the associate director of the Center for Clinical research and evidence-based Medicine at the UT Health Science Center at Houston.

Address correspondence to Virginia A. Moyer MD MPH 6431 Fannin St #2106 Houston, TX 77030 (e-mail: virginia.a.moyer@uth. tmcedu) Reprints are not available from the author.

COPYRIGHT 2006 American Academy of Family Physicians

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