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Ravel C, Nimal M, Nauleau S, Lapalus D, Bernard O, Gras E, Tardieu S, Boubred F. Association of early follow-up visits with reduced hospital readmissions of newborns: a French population-based data-linkage study. World J Pediatr 2024:10.1007/s12519-024-00841-y. [PMID: 39395089 DOI: 10.1007/s12519-024-00841-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 08/28/2024] [Indexed: 10/14/2024]
Abstract
BACKGROUND Newborn care guidelines recommend assessments within a week of discharge from maternity care. However, the optimal timing and effectiveness to prevent neonatal hospital readmission are debated. This study aimed to determine the association between early follow-up visits (EFVs) within three days of postpartum discharge and hospital readmission of newborns up to 15 days of life. METHODS This population-based data-linkage study used data from the French National Health Care Database. "Healthy" singleton term infants with a gestational age (GA) of ≥ 36 weeks, born between January 1, 2017, and November 30, 2018, in Southern France, were included. A multivariate regression analysis was performed. RESULTS Among the 67,359 included infants, 1519 (2.25%) were hospitalized. The principal causes of hospitalization were infectious diseases (42.4%) and jaundice or growth/nutrition disorders (36.1%). Hospitalized infants were more likely to be born to young and socioeconomically deprived mothers, to be male (54.4% vs. 50.6%, P < 0.001), or born early (GA < 38 weeks; 28.5% vs. 20.5%, P < 0.001). They received 6% less EFVs than non-hospitalized infants (63.7% vs. 67.8%, P < 0.001). The multivariable regression logistic analysis revealed that infants who received EFVs had 13% lower odds of being hospitalized than infants without EFVs, with an adjusted odds ratio of 0.87 (95% confidence interval = 0.78-0.96; P < 0.01). CONCLUSION EFVs within three days were associated with a 13% reduction in the rate of neonatal hospital readmission. Therefore, EFVs should be implemented to improve infant health and reduce healthcare costs.
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Affiliation(s)
- Camille Ravel
- APHM, Hospital University La Conception, Neonatal Unit, Service de Médecine Néonatale, 147 Boulevard Baille, 13005, Marseille, France
| | - Marion Nimal
- APHM, Hospital University La Conception, Neonatal Unit, Service de Médecine Néonatale, 147 Boulevard Baille, 13005, Marseille, France
| | - Steve Nauleau
- Regional Health Agency, Provence-Alpes-Côte d'Azur, France
| | - David Lapalus
- Regional Health Agency, Provence-Alpes-Côte d'Azur, France
| | | | - Elise Gras
- APHM, Hospital University La Conception, Neonatal Unit, Service de Médecine Néonatale, 147 Boulevard Baille, 13005, Marseille, France
| | - Sophie Tardieu
- APHM, Public Health and Medical Information Department, EA 3279, CEReSS-Health Service Research and Quality of Life Centre, Marseille, France
| | - Farid Boubred
- APHM, Hospital University La Conception, Neonatal Unit, Service de Médecine Néonatale, 147 Boulevard Baille, 13005, Marseille, France.
- Aix-Marseille University, INSERM, INRAE, C2VN, Marseille, France.
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Jubulis J, Goddard A, Dibrigida S, McCarthy C. Effects of Maternal SARS-CoV-2 Infection on Neonatal Discharge Planning and Care: Exacerbation of Racial and Ethnic Healthcare Disparities. J Racial Ethn Health Disparities 2024; 11:2530-2537. [PMID: 37500829 DOI: 10.1007/s40615-023-01718-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES To determine if SARS-CoV-2 disproportionately impacted infants born to racial and ethnic minorities and if virus exposure led to decreased access to care. METHODS This study was an observational case-control study, between March 2020 and March 2022 in Portland, Maine. Forty-seven cases and 47 controls were enrolled. Cases were infants born to mothers diagnosed with SARS-CoV-2 at delivery, and controls were infants matched by date of birth, born to SARS-CoV-2 negative women. Demographic data, maternal clinical data, infant outcomes, and infant discharge plans were compared using Chi squared or Fisher Exact tests. Logistic regression was used to examine the impact of race on neonatal SARS-CoV-2 exposure. RESULTS Infants exposed to SARS-CoV-2 were more likely Black or Hispanic than White and Non-Hispanic early in the pandemic, with reversal during the second year. SARS-CoV-2-exposed infants experienced delays in routine newborn outpatient care, although delay improved over the pandemic. CONCLUSION Infants exposed to SARS-CoV-2 were initially more likely to be infants of color. During this time, infants exposed to SARS-CoV-2 were also experiencing significant delays in newborn care.
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Affiliation(s)
- Jennifer Jubulis
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Portland, ME, USA.
| | - Amanda Goddard
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Portland, ME, USA
| | - Sarah Dibrigida
- Maine Medical Center Department of Pediatrics, Portland, ME, USA
| | - Carol McCarthy
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Portland, ME, USA
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3
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Kersting M, Sievers E, Hockamp N, Kalhoff H, Lücke T. Getting breastfeeding started under pandemic visiting restrictions: lessons learned in Germany. Int Breastfeed J 2024; 19:64. [PMID: 39272188 PMCID: PMC11401266 DOI: 10.1186/s13006-024-00664-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 08/09/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic contact restrictions considerably changed maternal visiting contacts during the time in which breastfeeding is initiated. We wanted to know how maternity ward staff and mothers rated the conditions of starting breastfeeding under contact restrictions. METHODS In the Breastfeeding in North Rhine-Westphalia (SINA) study, Germany, 2021/22, chief physicians as well as ward staff from 41 (out of 131) maternity hospitals (82 members of the healthcare sector in total) were surveyed by telephone concerning structural and practical conditions for breastfeeding support before and during the pandemic; 192 (out of 426 eligible) mothers answered an online-questionnaire about their breastfeeding experiences at 2 weeks and 2 months after birth. RESULTS In almost all of the hospitals, visits were restricted due to the pandemic, with the exception of the primary support person. After more than one year of pandemic experience, the ward staff were convinced that the restrictions were mostly positive for the mothers (97.6%) and for the ward staff themselves (78.0%). A total of 80.5% of the ward staff would maintain the restrictions beyond the pandemic. The mothers themselves mostly rated the restrictions in the hospital as being just right; moreover, many mothers voluntarily maintained the restrictions at home, at least in part. CONCLUSIONS The unprecedented visiting restrictions in hospitals during the pandemic were like an "experiment" born out of necessity. Restricting visiting arrangements may be an underestimated beneficial component for the development of the mother-infant dyad in perinatal breastfeeding care, particularly in healthcare systems where almost all births occur in the maternity hospital. TRIAL REGISTRATION German Clinical Trials Register (DRKS) (DRKS00027975).
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Affiliation(s)
- Mathilde Kersting
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany.
| | | | - Nele Hockamp
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
| | - Hermann Kalhoff
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
- Pediatric Clinic Dortmund, Dortmund, Germany
| | - Thomas Lücke
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef-Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
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4
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Greene LM, O'Connell R, Murphy M, Hegarty J. Procedural elements of the complete examination and screening of the healthy term neonate: a protocol for a scoping review and evidence map. BMJ Paediatr Open 2024; 8:e002286. [PMID: 38862161 PMCID: PMC11168178 DOI: 10.1136/bmjpo-2023-002286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 05/01/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION All newborns undergo a Complete Examination and Screening of the Neonate (CESoN) to verify the general health and well-being of the neonate and to screen for signs and symptoms of illness and significant congenital disorders, typically within 72 hours of birth. For healthy, term gestation neonates, this examination is usually performed by a qualified healthcare practitioner that is, a midwife, nurse or physician just prior to discharge from the maternity services. As a precursor to modifying and adapting an instrument that measures the quality of performance of the CESoN by healthcare professionals, this review aims to identify, evaluate, synthesise and map the evidence and theory underpinning current practice and the procedural elements of the CESoN. METHODS AND ANALYSIS This review will be guided by the Joanna Briggs Institute methodology for scoping reviews and also the recommendations of the Campbell Collaboration for systematic evidence mapping. Based on the research question, the Person, Concept, Context framework will be used to develop eligibility criteria for inclusion in the review. Eligible information shall be sourced by searching electronic databases including PubMed, Cumulative Index of Nursing and Allied Health Literature, and Scopus, and the published guidance from expert bodies on newborn examination and screening (eg, National Institute for Health and Care Excellence, American Academy of Pediatrics, Royal College of Paediatrics and Child Health) and the grey literature. This study will include primary and secondary research papers, evidence-based guidelines, and expert text and opinions published in English from 2013 to September 2023. ETHICS AND DISSEMINATION Ethical approval is not required for this scoping review and systematic evidence mapping. The results from this study will be disseminated through peer-reviewed format, that is, conference proceedings and peer-reviewed healthcare journals.
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Affiliation(s)
- Liz M Greene
- School of Nursing and Midwifery, University College Cork, College Road, Cork, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Rhona O'Connell
- School of Nursing and Midwifery, University College Cork, College Road, Cork, Ireland
| | - Margaret Murphy
- School of Nursing and Midwifery, University College Cork, College Road, Cork, Ireland
| | - Josephine Hegarty
- School of Nursing and Midwifery, University College Cork, College Road, Cork, Ireland
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Slemmer A, Klamer B, Schmerge C, Lauden S, Texler C, Fennell M, Lowing D, Leyenaar JK, Bode RS. Comparing Outcomes Between Direct and ED Admissions for Neonatal Hyperbilirubinemia. Hosp Pediatr 2024; 14:421-429. [PMID: 38766712 DOI: 10.1542/hpeds.2023-007527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES Pediatric direct admissions (DA) have multiple benefits including reduced emergency department (ED) volumes, greater patient and provider satisfaction, and decreased costs without compromising patient safety. We sought to compare resource utilization and outcomes between patients with a primary diagnosis of neonatal hyperbilirubinemia directly admitted with those admitted from the ED. METHODS Single-center, retrospective study at a large, academic, free-standing children's hospital (2017-2021). Patients were between 24 hours and 14 days old with a gestational age of ≥35 weeks, admitted with a primary diagnosis of neonatal hyperbilirubinemia. Outcomes included length of stay (LOS), time to clinical care, resource utilization, NICU transfer, and 7-day readmission for phototherapy. RESULTS A total of 1098 patients were included, with 276 (25.1%) ED admissions and 822 (74.9%) DAs. DAs experienced a shorter median time to bilirubin level collection (1.9 vs 2.1 hours, P = .003), received less intravenous fluids (8.9% vs 51.4%, P < .001), had less bilirubin levels collected (median of 3.0 vs 4.0, P < .001), received phototherapy sooner (median of 0.8 vs 4.2 hours, P < .001), and had a shorter LOS (median of 21 vs 23 hours, P = .002). One patient who was directly admitted required transfer to the NICU. No differences were observed in the 7-day readmission rates for phototherapy. CONCLUSIONS Directly admitting patients for the management of neonatal hyperbilirubinemia is a preferred alternative to ED admission as our study demonstrated that DAs had a shorter time to clinical care, shorter LOS, and less unnecessary resource utilization with no difference in 7-day readmissions for phototherapy.
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Affiliation(s)
- Ashleigh Slemmer
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Brett Klamer
- Biostatistics Resource at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio &The Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Christine Schmerge
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Stephanie Lauden
- Department of Pediatrics, The University of Colorado, Denver, Colorado
| | - Cara Texler
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Meghan Fennell
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Dena Lowing
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - JoAnna K Leyenaar
- Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Ryan S Bode
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Center for Clinical Excellence at Nationwide Children's Hospital, Columbus, Ohio
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Verganti C, Suttora C, Zuccarini M, Aceti A, Corvaglia L, Bello A, Caselli MC, Guarini A, Sansavini A. Lexical skills and gesture use: A comparison between expressive and receptive/expressive late talkers. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 148:104711. [PMID: 38520885 DOI: 10.1016/j.ridd.2024.104711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/05/2024] [Accepted: 02/22/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Studies on late talkers (LTs) highlighted their heterogeneity and the relevance of describing different communicative profiles. AIMS To examine lexical skills and gesture use in expressive (E-LTs) vs. receptive-expressive (R/E-LTs) LTs through a structured task. METHODS AND PROCEDURES Forty-six 30-month-old screened LTs were distinguished into E-LTs (n= 35) and R/E-LTs (n= 11) according to their receptive skills. Lexical skills and gesture use were assessed with a Picture Naming Game by coding answer accuracy (correct, incorrect, no response), modality of expression (spoken, spoken-gestural, gestural), type of gestures (deictic, representational), and spoken-gestural answers' semantic relationship (complementary, equivalent, supplementary). OUTCOMES AND RESULTS R/E-LTs showed lower scores than E-LTs for noun and predicate comprehension with fewer correct answers, and production with fewer correct and incorrect answers, and more no responses. R/E-LTs also exhibited lower scores in spoken answers, representational gestures, and equivalent spoken-gestural answers for noun production and in all spoken and gestural answers for predicate production. CONCLUSIONS AND IMPLICATIONS Findings highlighted more impaired receptive and expressive lexical skills and lower gesture use in R/E-LTs compared to E-LTs, underlying the relevance of assessing both lexical and gestural skills through a structured task, besides parental questionnaires and developmental scales, to describe LTs' communicative profiles.
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Affiliation(s)
- Caterina Verganti
- Department of Psychology "Renzo Canestrari", University of Bologna, Italy.
| | - Chiara Suttora
- Department of Psychology "Renzo Canestrari", University of Bologna, Italy
| | - Mariagrazia Zuccarini
- Department of Education Studies "Giovanni Maria Bertin", University of Bologna, Italy
| | - Arianna Aceti
- Neonatal Intensive Care Unit, IRCCS Azienda Ospedaliero Universitaria Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit, IRCCS Azienda Ospedaliero Universitaria Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | | | | | - Annalisa Guarini
- Department of Psychology "Renzo Canestrari", University of Bologna, Italy
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Groening P, Silver EJ, Nemerofsky SL. Decreasing the Newborn Birth Hospitalization Length of Stay. Am J Perinatol 2024; 41:e1362-e1367. [PMID: 36724873 DOI: 10.1055/a-2024-1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study aimed to determine our ability to shorten birth hospitalization length of stay (LOS) in which patient characteristics were associated with early discharge and had effects on early newborn readmission rate. STUDY DESIGN Retrospective chart review of births from April 1, 2020 to December 31, 2020, was considered for this study. Delivery mode and maternal and newborn characteristics were evaluated for effect on discharge timing. Hospital readmissions within 7 days of discharge were reviewed. RESULTS In total, 845 out of 1,077 total live births were included in the study population. Five hundred and eighty-nine (69.7%) newborns were discharged early (<48 hours after vaginal delivery [VD] and <72 hours after cesarean delivery [CS]). Factors associated with early discharge included 79.8% CS (p < 0.001), 84% birth after 2 p.m. (p < 0.001), 71.2% no diagnosis of maternal diabetes (p = 0.02), and 70.6% negative maternal coronavirus disease 2019 (p = 0.01). The overall 7-day readmission rate was 1.2 and 0.5% for newborns discharged early after VD. CONCLUSION Most newborns can be discharged early without increasing newborn readmission. KEY POINTS · Most patients were discharged <72 hours after CS.. · Most patients were discharged <48 hours after VD.. · Early discharge does not affect newborn readmissions..
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Affiliation(s)
- Portia Groening
- Albert Einstein College of Medicine, Bronx, New York
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | | | - Sheri L Nemerofsky
- Albert Einstein College of Medicine, Bronx, New York
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
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El Masri M, Samotiy-Hanna L, Ghabril R, Nassif Y, Al Hamod D. Too Much Salt to My Taste: An Entity to Think about in Neonatal Hypernatremia: A Case Report and Review of the Literature. Case Rep Pediatr 2024; 2024:8838362. [PMID: 38496374 PMCID: PMC10942816 DOI: 10.1155/2024/8838362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
In exclusively breastfed newborns, hypernatremic dehydration is associated with a free water deficit secondary to insufficient fluid intake. Failure of newborns to regain their birth weight by the 10th day of life should be investigated urgently. In this report, we present a case of a 2 -week-old girl who presented to our institution for 30% weight loss and was found to have severe hypernatremic dehydration associated with acute renal failure (creatinine 4 mg/dL). Upon further investigation, the breast milk sodium content was found to be extremely elevated (90 mEq/L). To our knowledge, the following reported case of severe neonatal hypernatremic dehydration associated with acute renal failure has the most elevated breast milk sodium content, serum sodium, and serum creatinine levels described in the literature. Thus, hypernatremic dehydration secondary to elevated breast milk content should always be borne in mind and investigated whenever suspected.
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Affiliation(s)
- Marwa El Masri
- Department of Pediatrics, Saint George University Medical Center, University of Balamand, Beirut, Lebanon
| | - Lidiya Samotiy-Hanna
- Department of Pediatrics, Saint George University Medical Center, University of Balamand, Beirut, Lebanon
| | - Ramy Ghabril
- Department of Pediatric Nephrology, Saint George University Medical Center, University of Balamand, Beirut, Lebanon
| | - Yolla Nassif
- Department of Pediatric and Neonatal Intensive Care, Saint George University Medical Center, University of Balamand, Beirut, Lebanon
| | - Dany Al Hamod
- Department of Pediatric and Neonatal Intensive Care, Saint George University Medical Center, University of Balamand, Beirut, Lebanon
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Barber CM, Terplan M. Principles of care for pregnant and parenting people with substance use disorder: the obstetrician gynecologist perspective. Front Pediatr 2023; 11:1045745. [PMID: 37292372 PMCID: PMC10246753 DOI: 10.3389/fped.2023.1045745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
Substance use in pregnant and parenting persons is common, yet still underdiagnosed. Substance use disorder (SUD) is one of the most stigmatized and undertreated chronic medical conditions, and this is exacerbated in the perinatal period. Many providers are not sufficiently trained in screening or treatment for substance use, so gaps in care for this population persist. Punitive policies towards substance use in pregnancy have proliferated, lead to decreased prenatal care, do not improve birth outcomes, and disproportionately impact Black, Indigenous, and other families of color. We discuss the importance of understanding the unique barriers of pregnancy-capable persons and drug overdose as one of the leading causes of maternal death in the United States. We highlight the principles of care from the obstetrician-gynecologist perspective including care for the dyad, person-centered language, and current medical terminology. We then review treatment of the most common substances, discuss SUD during the birthing hospitalization, and highlight the high risk of mortality in the postpartum period.
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Affiliation(s)
- Cecily May Barber
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, United States
- Department of Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States
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Della PR, Huang H, Roberts PA, Porter P, Adams E, Zhou H. Risk factors associated with 31-day unplanned hospital readmission in newborns: a systematic review. Eur J Pediatr 2023; 182:1469-1482. [PMID: 36705723 PMCID: PMC10167195 DOI: 10.1007/s00431-023-04819-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023]
Abstract
UNLABELLED The purpose of this study is to synthesize evidence on risk factors associated with newborn 31-day unplanned hospital readmissions (UHRs). A systematic review was conducted searching CINAHL, EMBASE (Ovid), and MEDLINE from January 1st 2000 to 30th June 2021. Studies examining unplanned readmissions of newborns within 31 days of discharge following the initial hospitalization at the time of their birth were included. Characteristics of the included studies examined variables and statistically significant risk factors were extracted from the inclusion studies. Extracted risk factors could not be pooled statistically due to the heterogeneity of the included studies. Data were synthesized using content analysis and presented in narrative and tabular form. Twenty-eight studies met the eligibility criteria, and 17 significant risk factors were extracted from the included studies. The most frequently cited risk factors associated with newborn readmissions were gestational age, postnatal length of stay, neonatal comorbidity, and feeding methods. The most frequently cited maternal-related risk factors which contributed to newborn readmissions were parity, race/ethnicity, and complications in pregnancy and/or perinatal period. CONCLUSION This systematic review identified a complex and diverse range of risk factors associated with 31-day UHR in newborn. Six of the 17 extracted risk factors were consistently cited by studies. Four factors were maternal (primiparous, mother being Asian, vaginal delivery, maternal complications), and two factors were neonatal (male infant and neonatal comorbidities). Implementation of evidence-based clinical practice guidelines for inpatient care and individualized hospital-to-home transition plans, including transition checklists and discharge readiness assessments, are recommended to reduce newborn UHRs. WHAT IS KNOWN • Attempts have been made to identify risk factors associated with newborn UHRs; however, the results are inconsistent. WHAT IS NEW • Six consistently cited risk factors related to newborn 31-day UHRs. Four maternal factors (primiparous, mother being Asian, vaginal delivery, maternal complications) and 2 neonatal factors (male infant and neonatal comorbidities). • The importance of discharge readiness assessment, including newborn clinical fitness for discharge and parental readiness for discharge. Future research is warranted to establish standardised maternal and newborn-related variables which healthcare providers can utilize to identify newborns at greater risk of UHRs and enable comparison of research findings.
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Affiliation(s)
- Phillip R Della
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia
| | - Haichao Huang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Pamela A Roberts
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia
| | - Paul Porter
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia.,Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Elizabeth Adams
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia.,European Federation of Nurses Associations, Clos du Parnasse, Brussels, 11A B-1050, Belgium
| | - Huaqiong Zhou
- Curtin School of Nursing, Curtin University, GPO Box U 1987, Perth, Western Australia, 6845, Australia. .,General Surgical Ward, Perth Children's Hospital, Nedlands, Western Australia, Australia.
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Egge JA, Anderson RH, Schimelpfenig MD. Care of the Well Newborn. Pediatr Rev 2022; 43:676-690. [PMID: 36450636 DOI: 10.1542/pir.2022-005511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Care of the newborn infant is a critical skill for general pediatricians and other providers in the practice of pediatric medicine. Optimal care relies on a thorough understanding of risk factors that may be present during the pregnancy and delivery, as well as the ability to recognize and address unanticipated problems in the postnatal period. This article focuses on antenatal care of the newborn, issues that present in the immediate postdelivery period, and care of the newborn after discharge. It also includes updated information on current topics in pediatric practice, such as the importance of vaccination, parental hesitancy in accepting common medical interventions, and updated guidelines related to the coronavirus disease 2019 pandemic. At the conclusion of the article, the reader should have a general understanding of antenatal risk factors that could affect the transition from the intrauterine environment and have the knowledge to address common issues that arise in the care of newborn infants.
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Affiliation(s)
- Justin A Egge
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
| | | | - Michelle D Schimelpfenig
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD.,Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
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12
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Neonatal Care Provider Tasks for Hospitalized Well Newborns. Adv Neonatal Care 2022; 22:523-530. [PMID: 34966057 DOI: 10.1097/anc.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Changes in the pediatrician's practice model have created demand for other medical care providers for hospitalized well newborns. Well newborn care may be the responsibility of those who work in any level I-IV neonatal intensive care units, whether in a primary or secondary role. No recent publications exist about how to approach the organization of tasks. PURPOSE The purpose of this article is to present a structure and resources to guide the organization of tasks in the care of hospitalized well newborns for learners or occasional care providers. METHODS The methods used in this project included literature review to develop evidence-based practice resources. The literature was reviewed regarding the relevant history and resources to support task organization of well newborn care provided by skilled providers in the hospital. The goal is to establish a reference to support education about these approaches, which appear to be rooted in tradition. FINDINGS Evidence-based resources include an overview of provider tasks and responsibilities for well newborn care for each hospital day and per shift. IMPLICATION FOR RESEARCH Future studies can measure mentor or learner perceptions of the value of these resources, critical thinking improvement, safety, and clinical outcomes. IMPLICATION FOR PRACTICE These resources may provide structure for learners or occasional providers who have studied the physiology, pathophysiology, and problem management concepts but need to learn how to execute their responsibilities in these busy environments.
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13
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Hasenstab KA, Jadcherla SR. Evidence-Based Approaches to Successful Oral Feeding in Infants with Feeding Difficulties. Clin Perinatol 2022; 49:503-520. [PMID: 35659100 DOI: 10.1016/j.clp.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Infants in the neonatal intensive care unit (NICU) frequently have feeding difficulties with the root cause remaining elusive to identify. Evaluation of the provider/parent/infant feeding process may provide objective clues to sources of feeding difficulty. Specialized testing may be necessary to determine if the infant's swallowing skills are dysfunctional, immature, or maldeveloped, and to determine the risk of feeding failure or chronic tube feeding. Current evidence-based diagnostic and management approaches resulting in successful oral feeding in the NICU infant are discussed.
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Affiliation(s)
- Kathryn A Hasenstab
- Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroads, Columbus, OH 43215, USA
| | - Sudarshan R Jadcherla
- Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroads, Columbus, OH 43215, USA; Division of Neonatology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Division Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, USA.
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14
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Reddy M, Tank N, Bawa M, Kanojia RP, Samujh R. Anorectal Malformations: The Earlier the Diagnosis, the Better the Outcome. Indian J Pediatr 2022; 89:536-540. [PMID: 34553299 DOI: 10.1007/s12098-021-03887-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 06/07/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To estimate the impact of delayed presentation of anorectal malformation (ARM) in neonates and to compare the presenting characteristics and outcomes of early versus delayed presentation. METHODS This is a prospective observational study of all neonates (age < 28 d) with ARM over 2 y. Delayed presentation was defined as presentation beyond 48 h of birth. Various presenting features and their early postoperative outcomes were compared. RESULTS Nearly half (26, 48%) of the 54 neonates with ARM had delayed presentation. Early and late presenters did not differ in terms of gender, gestational age, birth weight, place of delivery, and type of ARM (p > 0.05 for all). Delayed group had lower weight at presentation (p = 0.008), higher incidence of severe abdominal distension (p = 0.05), and sepsis (p = 0.171) and required longer time for resuscitation (p = 0.007) and more inotropes (p = 0.015), preoperatively. Early postoperative outcomes including time for stoma to function, initiate feeds and time to reach full feeds were significantly delayed in late presenters. They also had more wound infections, longer hospital stay and higher mortality. CONCLUSIONS Delayed diagnosis of ARM is associated with significantly higher morbidity and mortality. Adequate awareness and training of health workers for early identification of ARM by careful perineal examination of all newborns at birth is the need of the hour.
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Affiliation(s)
- Manasa Reddy
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Nilesh Tank
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Monika Bawa
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Ravi P Kanojia
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ram Samujh
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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15
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Smith H, Harvey C, Portela A. Discharge preparation and readiness after birth: a scoping review of global policies, guidelines and literature. BMC Pregnancy Childbirth 2022; 22:281. [PMID: 35382773 PMCID: PMC8985304 DOI: 10.1186/s12884-022-04577-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the existence of global recommendations, postnatal care provided following childbirth is variable and often fails to address a woman's concerns about herself and the parents' concerns about their baby. Discharge from a facility after birth is a key moment to ensure the woman, parents and newborn receive support for the transition to care in the home. We mapped the current policies, guidance and literature on discharge preparation and readiness to identify key concepts and evidence and inform recommendations to be considered in a World Health Organization (WHO) guidance on postnatal care. METHODS We were guided by the Johanna Briggs Institute approach, and developed inclusion criteria based on existing defintions of discharge preparation and readiness, and criteria for discharge readiness compiled by international professional organisaitons. To identify guidelines and policies we searched websites and archives of guideline organisations, and contacted individuals and professional societies working on postnatal care. We searched 14 electronic databases to locate published research and other literature on discharge preparation and readiness. For documents that met the inclusion criteria we extracted key characteristics, summarised discharge readiness criteria and components and discharge preparation steps, and characterised interventions to improve discharge preparation. RESULTS The review provides a systematic map of criteria for discharge that are in use and the common steps healthcare providers take in preparing women and newborns for the transition home. The mapping also identified interventions used to strengthen discharge preparation, theories and models that conceptualise discharge preparation, scales for measuring discharge readiness and qualitative studies on the perspectives of women, men and healthcare providers on postnatal discharge. CONCLUSIONS The findings highlight contrasts between the research literature and policy documents. They indicate potential gaps in current discharge policies, and point to the need for more comprehensive discharge assessment and education to better identify and meet the needs of women, parents/caregivers and families prior to discharge and identify those who may require additional support. PROTOCOL REGISTRATION DETAILS The protocol for the review was registered with protocols.io on 23 November 2020: https://doi.org/10.17504/protocols.io.bpzymp7w.
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Affiliation(s)
- Helen Smith
- International Health Consulting Services Ltd, Merseyside, UK.
| | | | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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16
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Schuh TL, Mithal LB, Naureckas S, Miller ES, Garfield CF, Shah MD. Outcomes from birth to 6 months of publicly insured infants born to mothers with severe acute respiratory syndrome coronavirus 2 infection in the United States. J Perinat Med 2022; 50:334-342. [PMID: 34882359 PMCID: PMC8997689 DOI: 10.1515/jpm-2021-0251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/29/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES We evaluated inpatient management, transition to home, breastfeeding, growth, and clinical outcomes of infants born to mothers diagnosed with SARS-CoV-2 infection in pregnancy and followed in a Federally Qualified Health Center (FQHC), that serves a diverse and low-income patient population, from birth through 6 months of life. METHODS Infants born between 4/3/20 and 7/26/20 at Prentice Women's Hospital with mothers who received prenatal care at Erie Family Health Center (Erie), the second largest FQHC in Illinois, and had confirmed SARS-CoV-2 during pregnancy were included. Data were abstracted from delivery hospital admission and outpatient follow-up appointments between 4/8/20 and 2/4/21. RESULTS Thirty-three infants met inclusion criteria. Average gestational age was 38.9 weeks (IQR 37.6-40.4), 3 (10%) were premature and 5 (15%) required NICU admission. Nearly all (97%) mothers expressed intent to breastfeed. Outpatient follow-up rates were similar to historical cohorts and 82% (23/28) of infants were vaccination compliant. Growth parameters showed normal distributions at all time points. At 6 months, any and exclusive breast milk feeding rates were lower compared to historic cohorts (18 vs. 36%, p<0.05, 0 vs. 21%, p<0.01). Three infants (10%) received development-related referrals, one carried an underlying genetic diagnosis. Outpatient visits were predominantly face-to-face with telemedicine use comprising only 6% of visits (11/182). CONCLUSIONS Longitudinal follow-up of 33 publicly insured infants born to mothers with SARS-CoV-2 infection in pregnancy followed in an FQHC showed high rates of follow-up and vaccination compliance, normal growth patterns and reassuring clinical status, and lower than expected rates of breastfeeding.
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Affiliation(s)
| | - Leena B. Mithal
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA,Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Sara Naureckas
- Erie Family Health Centers, Chicago, IL, USA,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Emily S. Miller
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Craig F. Garfield
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA,Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Malika D. Shah
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA,Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
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17
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Hoyt-Austin AE, Kair LR, Larson IA, Stehel EK. Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads, Revised 2022. Breastfeed Med 2022; 17:197-206. [PMID: 35302875 PMCID: PMC9206473 DOI: 10.1089/bfm.2022.29203.aeh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.
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Affiliation(s)
- Adrienne E Hoyt-Austin
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, California, USA
| | - Laura R Kair
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, California, USA
| | - Ilse A Larson
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth K Stehel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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18
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Consales A, Colombo L, Zanotta L, Morniroli D, Sannino P, Rampini S, Piccoli G, Donghi M, Marchisio P, Mosca F, Plevani L, Giannì ML. Pilot Feasibility Study of a Hospital-Based Post-Natal Educational Intervention on New Mothers in a BFHI-Compliant Tertiary Referral Center for Neonatal Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042020. [PMID: 35206209 PMCID: PMC8871806 DOI: 10.3390/ijerph19042020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022]
Abstract
The immediate post-partum period offers a valuable opportunity for parental education on various health topics. The aim of this study was to pilot test the feasibility in a tertiary referral center for neonatal care of a post-natal educational intervention (the Diary) designed to provide mothers with basic information concerning newborn care and breastfeeding. Furthermore, we aimed to evaluate its effect on exclusive breastfeeding rates at discharge and at 48 h post-discharge, and on maternal perceived support during hospital stay, compared to standard care. A single-center two-phase interventional study was carried out from 1 December 2018 to 2 June 2019. The Diary was given to mothers enrolled in Phase 2, together with the Nurse-Parent Support Tool (NPST). The Diary-NPST couples analyzed were 269. The Diaries filled out and returned were 62.2%. Overall, mothers rated the information received through the Diary as "clear and comprehensive". Exclusive breastfeeding rates at discharge resulted in being higher in Phase 1 than in Phase 2 (80.6% vs. 72.5%, p = 0.04), whereas no difference emerged in terms of exclusive breastfeeding rates at 48 h. In both phases, the median NPST total score (4.05) was high. In conclusion, we propose a new instrument of in-hospital post-natal maternal education and, in line with the current literature, we support well-designed written educational materials to promote mothers' knowledge and satisfaction with post-partum hospital assistance. Further studies that are multicentric and with a longer follow-up period are needed to evaluate the potential impact of the Diary on exclusive breastfeeding duration.
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Affiliation(s)
- Alessandra Consales
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
| | - Lorenzo Colombo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
| | - Lidia Zanotta
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
| | - Daniela Morniroli
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
- Correspondence: ; Tel.: +39-0255032907
| | - Patrizio Sannino
- Direzione Professioni Sanitarie, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy; (P.S.); (S.R.)
| | - Serena Rampini
- Direzione Professioni Sanitarie, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy; (P.S.); (S.R.)
| | - Giulia Piccoli
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
| | - Michaela Donghi
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
| | - Paola Marchisio
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Pediatric Unit, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
| | - Laura Plevani
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
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19
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Vohr BR, McGowan EC, Brumbaugh JE, Hintz SR. Overview of Perinatal Practices with Potential Neurodevelopmental Impact for Children Affected by Preterm Birth. J Pediatr 2022; 241:12-21. [PMID: 34673090 DOI: 10.1016/j.jpeds.2021.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/27/2021] [Accepted: 10/15/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Betty R Vohr
- Department of Pediatrics, Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI.
| | - Elisabeth C McGowan
- Department of Pediatrics, Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI
| | - Jane E Brumbaugh
- Children's Center of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA
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20
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Hochreiter D, Kuruvilla D, Grossman M, Silberg J, Rodriguez A, Lary L, Panosky K, Loyal J. Improving Guidance and Maternal Knowledge Retention After Well-Newborn Unit Discharge. Hosp Pediatr 2022; 12:148-156. [PMID: 35075487 DOI: 10.1542/hpeds.2021-006307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES In 2015, the American Academy of Pediatrics published a policy statement to provide best practices on mother-infant discharge criteria, including the delivery of anticipatory guidance to mothers of healthy newborns. In our large health system with a mix of hospital types, no standard approach to or measurement of the effectiveness of newborn discharge guidance exists. At one community well-newborn unit, we aimed to increase maternal knowledge retention of newborn guidance from 69% to 90%. METHODS Data about newborn guidance effectiveness were collected by assessing maternal knowledge retention through phone follow-up quizzes. By using quality improvement methodology and informed by American Academy of Pediatrics guidelines and curricular and adult learning theory, we standardized a multidisciplinary approach to this education. Interventions included checklist, scripts, temperature-taking demonstration, gift thermometer, staff education, car seat infant mannequin, and car seat training video for staff. RESULTS Over a 1-year period, 333 mothers were interviewed after discharge from the well-newborn unit. Baseline data over the first 3 months (n = 93) showed poor maternal knowledge retention (69% correct answers). Common incorrect answers were on newborn urination habits, car seat harness clip positioning, and fever recognition. After restructuring the educational process, special cause was achieved after 3 months, with a shift of the average of correct answers to 83% followed by a second shift to 86%. CONCLUSIONS The implementation of interventions to standardize newborn discharge guidance resulted in marked and sustained improvement in maternal knowledge after well-newborn unit discharge. Our next step is to enhance the process by using videos with systemwide implementation.
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Affiliation(s)
- Daniela Hochreiter
- Division of Hospitalist Medicine, Department of Pediatrics, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Danice Kuruvilla
- Division of Hospitalist Medicine, Department of Pediatrics, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Matthew Grossman
- Division of Hospitalist Medicine, Department of Pediatrics, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Jordan Silberg
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Alexis Rodriguez
- Division of Hospitalist Medicine, Department of Pediatrics, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Lauren Lary
- Lawrence and Memorial Hospital, Yale New Haven Health, New London, Connecticut
| | - Kelsey Panosky
- Lawrence and Memorial Hospital, Yale New Haven Health, New London, Connecticut
| | - Jaspreet Loyal
- Division of Hospitalist Medicine, Department of Pediatrics, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
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21
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Handley SC, Gallagher K, Breden A, Lindgren E, Lo JY, Son M, Murosko D, Dysart K, Lorch SA, Greenspan J, Culhane JF, Burris HH. Birth Hospital Length of Stay and Rehospitalization During COVID-19. Pediatrics 2022; 149:e2021053498. [PMID: 34889449 PMCID: PMC9645693 DOI: 10.1542/peds.2021-053498] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To determine if birth hospitalization length of stay (LOS) and infant rehospitalization changed during the coronavirus disease 2019 (COVID-19) era among healthy, term infants. METHODS Retrospective cohort study using Epic's Cosmos data from 35 health systems of term infants discharged ≤5 days of birth. Short birth hospitalization LOS (vaginal birth <2 midnights; cesarean birth <3 midnights) and, secondarily, infant rehospitalization ≤7 days after birth hospitalization discharge were compared between the COVID-19 (March 1 to August 31, 2020) and prepandemic eras (March 1 to August 31, 2017, 2018, 2019). Mixed-effects models were used to estimate adjusted odds ratios (aORs) comparing the eras. RESULTS Among 202 385 infants (57 110 from the COVID-19 era), short birth hospitalization LOS increased from 28.5% to 43.0% for all births (vaginal: 25.6% to 39.3%, cesarean: 40.1% to 61.0%) during the pandemic and persisted after multivariable adjustment (all: aOR 2.30, 95% confidence interval [CI] 2.25-2.36; vaginal: aOR 2.12, 95% CI 2.06-2.18; cesarean: aOR 3.01, 95% CI 2.87-3.15). Despite shorter LOS, infant rehospitalizations decreased slightly during the pandemic (1.2% to 1.1%); results were similar in adjusted analysis (all: aOR 0.83, 95% CI 0.76-0.92; vaginal: aOR 0.82, 95% CI 0.74-0.91; cesarean: aOR 0.87, 95% CI 0.69-1.10). There was no change in the proportion of rehospitalization diagnoses between eras. CONCLUSIONS Short infant LOS was 51% more common in the COVID-19 era, yet infant rehospitalization within a week did not increase. This natural experiment suggests shorter birth hospitalization LOS among family- and clinician-selected, healthy term infants may be safe with respect to infant rehospitalization, although examination of additional outcomes is needed.
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Affiliation(s)
- Sara C. Handley
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | | | | | | | | | - Moeun Son
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Daria Murosko
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kevin Dysart
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott A. Lorch
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Jay Greenspan
- Division of Neonatology, Nemours duPont Pediatrics, Philadelphia, Pennsylvania
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Heather H. Burris
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
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22
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Meek JY, Carmona CA, Mancini EM. Problems of the Newborn and Infant. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Leff M, Loyal J. The Term Newborn: Alternative Birth Practices, Refusal, and Therapeutic Hesitancy. Clin Perinatol 2021; 48:647-663. [PMID: 34353585 DOI: 10.1016/j.clp.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The care of late preterm and term newborns delivered in hospital settings in the United States is largely standardized with many routine interventions and screenings that are evidence-based and serve to protect newborn's and the public's health. Refusals of various aspects of routine newborn care are uncommon but can be challenging for clinicians who care for newborns to navigate for many reasons. In this article, we describe the spectrum of refusal. We review suggested approaches that clinicians can take starting with increasing their own awareness of what specific components of newborn care are refused and why.
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Affiliation(s)
- Michelle Leff
- Department of Pediatrics, University of California San Diego.
| | - Jaspreet Loyal
- Department of Pediatrics, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
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Abstract
This article attempts to highlight contemporary issues relating to term neonatal hyperbilirubinemia and to focus attention on controversial issues and concepts with the potential to effect change in clinical approach. On the one hand, the focus is bilirubin neurotoxicity, which is now known to encompass a wide, diverse spectrum of features. The various aspects of this spectrum are outlined and defined. On the other hand, bilirubin also possesses antioxidant properties. As such, mild hyperbilirubinemia is suggested as actually offering the neonate some protective advantage.
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25
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Yagiela LM, Pfarr MA, Meert KL, Odetola FO. Posthospitalization follow-up recommendations after pediatric critical illness due to respiratory failure. Pediatr Pulmonol 2021; 56:1745-1753. [PMID: 33644972 DOI: 10.1002/ppul.25343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To characterize the recommended posthospitalization follow-up by provider type and location after a pediatric critical illness due to respiratory failure. WORKING HYPOTHESIS After pediatric critical illness due to respiratory failure, patients will not have a standard follow-up pattern with regard to provider type or follow-up location. STUDY DESIGN A retrospective cohort study. SUBJECT SELECTION Children, 18 years or younger, admitted to a quaternary care pediatric intensive care unit with respiratory failure between January 1, 2013 and December 31, 2014. METHODOLOGY For eligible patients, recommendations for posthospitalization follow-up including provider type (primary care and specialty care) and location (community care center vs. tertiary care center) were characterized from medical chart review. Recommendations were examined for all patients and two patient subgroups (patients who received extracorporeal membrane oxygenation and patients with tracheostomy). RESULTS Of 155 patients alive at hospital discharge, the median age was 2.1 (interquartile range, 0.7-10.6) years. Eighty percent of patients were instructed to follow-up with a primary care provider but only 52.9% with a pulmonologist. We found 10 unique follow-up patterns between provider location (community care center, tertiary care center, or both) and global provider type (primary care versus specialty care). Primary care follow-up was recommended more often at community locations (74.2%), whereas specialty care was more often recommended at tertiary care centers (68.6%). CONCLUSIONS Our study findings demonstrate significant variability in the recommendations for follow-up by provider type and location after hospitalization for acute respiratory failure and highlight areas for improvement in follow-up care after pediatric critical illness.
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Affiliation(s)
- Lauren M Yagiela
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA.,Department of Pediatrics, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Marie A Pfarr
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Kathleen L Meert
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA.,Department of Pediatrics, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Fola O Odetola
- Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.,Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
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Auriti C, De Rose DU, Mondì V, Stolfi I, Tzialla C. Neonatal SARS-CoV-2 Infection: Practical Tips. Pathogens 2021; 10:pathogens10050611. [PMID: 34067588 PMCID: PMC8157198 DOI: 10.3390/pathogens10050611] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/02/2021] [Accepted: 05/13/2021] [Indexed: 02/05/2023] Open
Abstract
The recent viral pandemic in Wuhan, Hubei, China has led to the identification of a new species of beta-coronavirus, able to infect humans, the 2019-nCoV, later named SARS-CoV-2. SARS-CoV-2 causes a clinical syndrome named COVID-19, which presents with a spectrum of symptoms ranging from mild upper respiratory tract infection to severe pneumonia, with acute respiratory distress syndrome and frequent death. All age groups are susceptible to the infection, but children, especially infants, seem to be partially spared, having a more favorable clinical course than other age groups. There is currently no clear evidence showing vertical transmission and intrauterine SARS-CoV-2 infection in fetuses of women developing COVID-19 pneumonia in late pregnancy, and even if transmission is possible, the SARS-CoV2 positivity of the mother does not require delivery by caesarean section, does not contraindicate the management of the infant in rooming-in and allows breastfeeding. This review provides an overview on the biology of the virus, on the pathogenesis of the infection, with particular attention to pregnancy and neonatal age, on the clinical presentation of infection in newborns and young infants and summarizes the international recommendations currently available on the clinical care of neonates with SARS-CoV2 infection or at risk of catching the virus. The main objective of the review is to provide an update especially focused to the clinical management of COVID-19 infection in the perinatal and neonatal age.
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Affiliation(s)
- Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant—“Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy;
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant—“Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy;
- Correspondence: or ; Tel.: +39-06-6859-2427; Fax: +39-06-6859-3916
| | - Vito Mondì
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino Hospital, 00169 Rome, Italy;
| | - Ilaria Stolfi
- Department of Neonatology, Policlinico Umberto I, “Sapienza” University, 00161 Rome, Italy;
| | - Chryssoula Tzialla
- Neonatal Intensive Care Unit and Neonatal pathology Unit, Policlinico San Matteo IRCCS Foundation, 27100 Pavia, Italy;
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Predicting NICU admissions in near-term and term infants with low illness acuity. J Perinatol 2021; 41:478-485. [PMID: 32678315 PMCID: PMC7855290 DOI: 10.1038/s41372-020-0723-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/29/2020] [Accepted: 07/07/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Describe NICU admission rate variation among hospitals in infants with birthweight ≥2500 g and low illness acuity, and describe factors that predict NICU admission. STUDY DESIGN Retrospective study from the Vizient Clinical Data Base/Resource Manager®. Support vector machine methodology was used to develop statistical models using (1) patient characteristics (2) only the indicator for the inborn hospital and (3) patient characteristics plus indicator for the inborn hospital. RESULTS NICU admission rates of 427,449 infants from 154 hospitals ranged from 0 to 28.6%. C-statistics for the patient characteristics model: 0.64 (Confidence Interval (CI) 0.62-0.65), hospital only model: 0.81 (CI, 0.81-0.82), and patient characteristic plus hospital variable model: 0.84 (CI, 0.83-0.84). CONCLUSION/RELEVANCE There is wide variation in NICU admission rates in infants with low acuity diagnoses. In all cohorts, birth hospital better predicted NICU admission than patient characteristics alone.
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Perrine CG, Chiang KV, Anstey EH, Grossniklaus DA, Boundy EO, Sauber-Schatz EK, Nelson JM. Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 - United States, July 15-August 20, 2020. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1767-1770. [PMID: 33237892 PMCID: PMC7727601 DOI: 10.15585/mmwr.mm6947a3] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Breastfeeding has health benefits for both infants and mothers and is recommended by numerous health and medical organizations*,† (1). The birth hospitalization is a critical period for establishing breastfeeding; however, some hospital practices, particularly related to mother-newborn contact, have given rise to concern about the potential for mother-to-newborn transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (2). CDC conducted a COVID-19 survey (July 15-August 20, 2020) among 1,344 hospitals that completed the 2018 Maternity Practices in Infant Nutrition and Care (mPINC) survey to assess current practices and breastfeeding support while in the hospital. Among mothers with suspected or confirmed COVID-19, 14.0% of hospitals discouraged and 6.5% prohibited skin-to-skin care; 37.8% discouraged and 5.3% prohibited rooming-in; 20.1% discouraged direct breastfeeding but allowed it if the mother chose; and 12.7% did not support direct breastfeeding, but encouraged feeding of expressed breast milk. In response to the pandemic, 17.9% of hospitals reported reduced in-person lactation support, and 72.9% reported discharging mothers and their newborns <48 hours after birth. Some of the infection prevention and control (IPC) practices that hospitals were implementing conflicted with evidence-based care to support breastfeeding. Mothers who are separated from their newborn or not feeding directly at the breast might need additional postdischarge breastfeeding support. In addition, the American Academy of Pediatrics (AAP) recommends that newborns discharged before 48 hours receive prompt follow-up with a pediatric health care provider.
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Isayama T, O'Reilly D, Beyene J, Shah PS, Lee SK, McDonald SD. Hospital Care Cost and Resource Use of Early Discharge of Healthy Late Preterm and Term Singletons: A Population-based Cohort Study and Cost Analysis. J Pediatr 2020; 226:96-105.e7. [PMID: 32610167 DOI: 10.1016/j.jpeds.2020.06.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/12/2020] [Accepted: 06/19/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the hospital care cost and resource use associated with discharge timings after late preterm and term births. STUDY DESIGN This population-based cohort study and cost analysis included all healthy singleton late preterm (35-36 weeks gestational age) and term infants (37-41 weeks gestational age) born vaginally in hospitals in Ontario, Canada, from 2003 to 2012. Early, late, and very late discharge (<48, 48-71, and 72-95 hours after birth, respectively) were compared using generalized linear models. The primary outcome was the total hospital care cost (hospitalizations and emergency department visits) per infant within 28 days of birth. RESULTS Among 860 693 singletons (3.7% late preterm), early discharge increased significantly over 10 years for term infants (from 69% to 82%; P < .001), but not late preterm infants (from 32% to 35%; P = .75). The mean total cost within 28 days after birth was not significantly different for late preterm infants between early discharge and late discharge after adjustment. However, for term infants, the adjusted cost was higher with early discharge than late discharge (aMCD $311 [95% CI, $211-$412] per infant; $366 [95% CI, $355-$377] per mother-infant dyad). The neonatal readmission rates were higher after early than late discharge for late preterm and term infants. CONCLUSIONS Early discharge was not associated with cost savings for vaginally born healthy singleton late preterm infants, and instead was associated with a cost increase for term infants. Early discharge was associated with higher neonatal readmission rates. Individualized approach balancing the risk and benefit is appropriate to determine the discharge timings.
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Affiliation(s)
- Tetsuya Isayama
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Newborn and Developmental Pediatrics, Sunnybrook Health Science Centre, Toronto, Ontario, Canada; Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan.
| | - Daria O'Reilly
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Prakesh S Shah
- Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sarah D McDonald
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada; Department of Radiology, McMaster University, Hamilton, Ontario, Canada
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Hua W, Yuwen W, Simoni JM, Yan J, Jiang L. Parental readiness for hospital discharge as a mediator between quality of discharge teaching and parental self-efficacy in parents of preterm infants. J Clin Nurs 2020; 29:3754-3763. [PMID: 32644290 DOI: 10.1111/jocn.15405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/28/2020] [Accepted: 06/21/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the extent to which parental readiness for hospital discharge mediates the relationship between quality of discharge teaching and parental self-efficacy in parents of preterm infants. BACKGROUND Parental readiness for hospital discharge and self-efficacy should be considered to establish whether preterm infants and their families are prepared for the discharge. High-quality discharge teaching could facilitate a smooth discharge transition. However, little is known about how quality of discharge teaching influences parental readiness for hospital discharge and self-efficacy. DESIGN This was a descriptive cross-sectional study of 202 parents with preterm infants in a tertiary hospital in Eastern China. METHODS The key variables of interest were measured using the Chinese versions of the Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale-Parent Form, and Preterm Parenting and Self-Efficacy Checklist. Path analyses were conducted to test the mediation models. STROBE checklist was used to compile the study's report. RESULTS Parental readiness for discharge (overall and knowledge dimension) partially mediated the relationship between the quality of discharge teaching and parental self-efficacy. The two dimensions (content received and delivery) of quality of discharge teaching positively influenced parental self-efficacy by improving parental readiness for discharge. CONCLUSIONS Parental readiness for hospital discharge, especially the knowledge dimension, was an important factor in quality of discharge teaching's association with self-efficacy in parents of preterm infants. Improving the quality of discharge teaching could increase parental readiness for discharge and thus promote parental self-efficacy. RELEVANCE TO CLINICAL PRACTICE Improving discharge instructions is essential to help parents of preterm infants prepare for the transition to home care. Assessing readiness and confidence at an early stage and continuing to do so throughout the hospital stay may provide additional ways for nurses to identify parents' knowledge gaps and to provide tailored interventions at more opportune times before hospital discharge.
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Affiliation(s)
- Wenzhe Hua
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Weichao Yuwen
- Nursing and Healthcare Leadership, University of Washington Tacoma, Tacoma, WA, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Jie Yan
- Neonatology Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liping Jiang
- Chief Nursing Officer, Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Management of neonates after postpartum discharge and all children in the ambulatory setting during the coronavirus disease 2019 (COVID-19) pandemic. Curr Opin Pediatr 2020; 32:610-618. [PMID: 32618790 PMCID: PMC7363367 DOI: 10.1097/mop.0000000000000931] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The present coronavirus disease 2019 (COVID-19) pandemic has created additional challenges with an increased number of presumed healthy, full-term newborns being discharged at 24 h after delivery. Short lengths of stay raise the possibility of mother-infant dyads being less ready for discharge, defined as at least one of the three informants (i.e., mother, pediatrician, and obstetrician) believing that either the mother and/or infant should stay longer than the proposed time of discharge. This public health crisis has reduced the number of in-person well child visits, negatively impacting vaccine receipt, and anticipatory guidance. RECENT FINDINGS Extra precautions should be taken during the transition period between postpartum discharge and follow-up in the ambulatory setting to ensure the safety of all patients and practice team members. This should include restructuring office flow by visit type and location, limiting in-person visits during well infant exams, instituting proper procedures for personal protective equipment and for cleaning of the office, expanding telehealth capabilities for care and education, and prioritizing universal vaccinations and routine well child screenings. SUMMARY Based on current limited evidence, this report provides guidance for the postdischarge management of newborns born to mothers with confirmed or suspected disease in the ambulatory setting as well as prioritizing universal immunizations and routine well child screenings during the COVID-19 pandemic.
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Abstract
The American Academy of Pediatrics (AAP) believes that current data show that hospitals and accredited birth centers are the safest settings for birth in the United States. The AAP does not recommend planned home birth, which has been reported to be associated with a twofold to threefold increase in infant mortality in the United States. The AAP recognizes that women may choose to plan a home birth. This statement is intended to help pediatricians provide constructive, informed counsel to women considering home birth while retaining their role as child advocates and to summarize appropriate care for newborn infants born at home that is consistent with care provided for infants born in a medical care facility. Regardless of the circumstances of his or her birth, including location, every newborn infant deserves health care consistent with that highlighted in this statement, which is more completely described in other publications from the AAP, including Guidelines for Perinatal Care and the Textbook of Neonatal Resuscitation All health care clinicians and institutions should promote communications and understanding on the basis of professional interaction and mutual respect.
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Affiliation(s)
- Kristi Watterberg
- Department of Pediatrics, The University of New Mexico, Albuquerque, New Mexico
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Kaplan M, Zimmerman D, Shoob H, Stein‐Zamir C. Post-discharge neonatal hyperbilirubinemia surveillance. Acta Paediatr 2020; 109:923-929. [PMID: 31742751 DOI: 10.1111/apa.15096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/15/2019] [Accepted: 11/15/2019] [Indexed: 11/28/2022]
Abstract
AIM To assess implementation of the Israel Neonatal Society's 2008 guidelines for universal community assessment of jaundice within 72 hours of discharge from birth hospitalisation. METHODS Mothers of newborns were interviewed at Maternal Child Health Clinics in the Jerusalem District, Israel, and asked whether their newborn had been evaluated for jaundice within the recommended time frame. Newborn discharge letters from Israeli hospitals were assessed for appropriate inclusion of instructions for early follow-up for jaundice. RESULTS Out of 659, 217 (32.9%) mothers whose newborns were at low risk for neonatal hyperbilirubinemia reported an examination within 72 hours of discharge. Eighteen (8.3%) were referred for a bilirubin test. In contrast, 99.1% (109/110) of high-risk newborns who were specifically invited for a bilirubin test the day following discharge complied. Out of 26, 12 (46.2%) hospital discharge letters specified both a time limit of 72 hours post-discharge and jaundice as a reason for early follow-up. CONCLUSION The early community surveillance rate for jaundice was low, contrasting with near universal compliance in those who received a specific instruction for a post-discharge bilirubin blood test. Inclusion of specific written instructions in hospital discharge summaries was also low and may contribute to poor implementation of guidelines.
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Affiliation(s)
- Michael Kaplan
- Jerusalem District Health Office Israel Ministry of Health Jerusalem Israel
- Faculty of Medicine The Hebrew University Jerusalem Israel
| | - Deena Zimmerman
- Jerusalem District Health Office Israel Ministry of Health Jerusalem Israel
- Faculty of Medicine The Hebrew University Jerusalem Israel
| | - Hanna Shoob
- Jerusalem District Health Office Israel Ministry of Health Jerusalem Israel
| | - Chen Stein‐Zamir
- Jerusalem District Health Office Israel Ministry of Health Jerusalem Israel
- Faculty of Medicine The Hebrew University Jerusalem Israel
- Braun School of Public Health and Community Medicine The Hebrew University Jerusalem Israel
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Problems of the Newborn and Infant. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_163-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Meek JY, Carmona CA, Mancini EM. Problems of the Newborn and Infant. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stewart DL, Barfield WD. Updates on an At-Risk Population: Late-Preterm and Early-Term Infants. Pediatrics 2019; 144:peds.2019-2760. [PMID: 31636141 DOI: 10.1542/peds.2019-2760] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics published a clinical report on late-preterm (LPT) infants in 2007 that was largely based on a summary of a 2005 workshop convened by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, at which a change in terminology from "near term" to "late preterm" was proposed. This paradigm-shifting recommendation had a remarkable impact: federal agencies (the Centers for Disease Control and Prevention), professional societies (the American Academy of Pediatrics and American College of Obstetricians and Gynecologists), and organizations (March of Dimes) initiated nationwide monitoring and educational plans that had a significant effect on decreasing the rates of iatrogenic LPT deliveries. However, there is now an evolving concern. After nearly a decade of steady decreases in the LPT birth rate that largely contributed to the decline in total US preterm birth rates, the birth rate in LPT infants has been inching upward since 2015. In addition, evidence revealed by strong population health research demonstrates that being born as an early-term infant poses a significant risk to an infant's survival, growth, and development. In this report, we summarize the initial progress and discuss the potential reasons for the current trends in LPT and early-term birth rates and propose research recommendations.
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Affiliation(s)
- Dan L Stewart
- School of Medicine, University of Louisville, Louisville, Kentucky; and
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Quality Improvement Learning Collaborative Improves Timely Newborn Follow-Up Appointments. Jt Comm J Qual Patient Saf 2019; 45:808-813. [PMID: 31607501 DOI: 10.1016/j.jcjq.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND American Academy of Pediatrics guidelines indicate that newborns should follow up with their primary care providers within three days of discharge from the newborn nursery. Many barriers exist to achieving timely follow-up, with potential implications on a newborn's health. The goal of this project was to improve rates of timely newborn follow-up through a nine-month quality improvement learning collaborative (QILC). Timely newborn follow-up was defined as an appointment scheduled within three days of newborn discharge. METHODS Both inpatient hospitalist and outpatient pediatric practices were eligible to participate. Inpatient and outpatient practices aimed to have 75% of newborns scheduled appropriately by six months into the project. In addition, outpatient practices aimed to have 60% of newborns seen appropriately by their provider. All practices aimed to have their progress sustained at conclusion of the QILC. Practices submitted data at baseline and nine subsequent phases. Monthly webinars featured a quality improvement didactic, data review, and discussion of practices' changes, successes, and challenges. RESULTS Eleven practices and 24 physicians participated in the QILC. Aggregate data from the practices showed continual improvement in all measured newborn scheduling metrics throughout the nine-month learning collaborative, with sustainment of progress over the last three months of the QILC. CONCLUSION A QILC is successful for increasing timely newborn follow-up for both the newborn hospitalist and outpatient pediatrician. Pediatric providers can learn from others' strategies and successes to incorporate meaningful changes in their practice.
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IJsselhof R, Liu H, Pigula F, Gauvreau K, Mayer JE, Nido PD, Nathan M. Rates of Interventions in Isolated Coarctation Repair in Neonates Versus Infants: Does Age Matter? Ann Thorac Surg 2019; 107:180-186. [DOI: 10.1016/j.athoracsur.2018.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 06/25/2018] [Accepted: 07/03/2018] [Indexed: 11/16/2022]
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Lemyre B, Jefferies AL, O'Flaherty P. Facilitating discharge from hospital of the healthy term infant. Paediatr Child Health 2018; 23:515-531. [PMID: 30894791 DOI: 10.1093/pch/pxy127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This statement provides guidance for health care providers to ensure the safe discharge of healthy term infants who are born in hospital and who are ≥37 weeks' gestational age. Hospital care for mothers and infants should be family-centred, with healthy mothers and infants remaining together and going home at the same time. The specific length of stay for newborn infants depends on the health of their mother, infant health and stability, the mother's ability to care for her infant, support at home, and access to follow-up care. Many mother-infant dyads are ready to go home 24 h after birth. Parent or guardian education and assessment of discharge readiness are important components of discharge planning. Each infant must have an appropriate discharge plan, including identification of the infant's primary health care provider and assessment by a health care provider 24 h to 72 h after discharge.
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Affiliation(s)
- Brigitte Lemyre
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
| | - Ann L Jefferies
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
| | - Pat O'Flaherty
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
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Lemyre B, Jefferies AL, O’Flaherty P. Faciliter le congé du nouveau-né à terme et en santé. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brigitte Lemyre
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
| | - Ann L Jefferies
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
| | - Pat O’Flaherty
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
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Arora NS, Danicek AM, Osborn RR, Fried SQ, Negris OR, Lychuk K, Mychaliska KP, Skoczylas MS, Monroe KK. Adherence to AAP Healthy Newborn Discharge Criteria in a Tertiary Care Children's Hospital. Hosp Pediatr 2018; 8:665-671. [PMID: 30279199 DOI: 10.1542/hpeds.2018-0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In 2015, the American Academy of Pediatrics (AAP) published an updated consensus statement containing 17 discharge recommendations for healthy term newborn infants. In this study, we identify whether the AAP criteria were met before discharge at a tertiary care academic children's hospital. METHODS A stratified random sample of charts from newborns who were discharged between June 1, 2015, and May 31, 2016, was reviewed. Of the 531 charts reviewed, 433 were included in the study. A review of each chart was performed, and data were collected. RESULTS Descriptive statistics for our study population (N = 433) revealed that all 17 criteria were followed <5% of the time. The following criteria were met 100% of the time: clinical course and physical examination, postcircumcision bleeding, availability of family members or health care providers to address follow-up concerns, anticipatory guidance, first appointment with the physician scheduled or parents knowing how to do so, pulse oximetry screening, and hearing screening. These criteria were met at least 95% to 99% of the time: appropriate vital signs, regular void and stool frequency, appropriate jaundice and sepsis management, and metabolic screening. The following criteria were met 50% to 95% of the time: maternal serologies, hepatitis B vaccination, and social risk factor assessment. Four of the criteria were met <50% of the time: feeding assessment, maternal vaccination, follow-up timing for newborns discharged at <48 hours of life, and car safety-seat assessment. CONCLUSIONS Our data reveal that the AAP healthy term newborn discharge recommendations are not consistently followed in our institution.
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Affiliation(s)
| | - Anne M Danicek
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, Michigan
| | - Rachel R Osborn
- Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, Michigan; and
| | - Sarah Q Fried
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, Michigan
| | - Olivia R Negris
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, Michigan
| | - Karson Lychuk
- College of Arts and Sciences, Loyola University Chicago, Chicago, Illinois
| | - Kerry P Mychaliska
- Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, Michigan; and
| | - Maria S Skoczylas
- Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, Michigan; and
| | - Kimberly K Monroe
- Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, Michigan; and
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Gorman S, Lee A, Amin R, Burns JJ. Potential Adverse Consequences of Early Discharge for Newborns Who Meet American Academy of Pediatrics Criteria. Clin Pediatr (Phila) 2018; 57:352-354. [PMID: 28357921 DOI: 10.1177/0009922817698807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Amy Lee
- 1 Florida State University, Pensacola, FL, USA
| | - Raid Amin
- 2 University of West Florida, Pensacola, FL, USA
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Milambo JPM, Cho K, Okwundu C, Olowoyeye A, Ndayisaba L, Chand S, Corden MH. Newborn follow-up after discharge from a tertiary care hospital in the Western Cape region of South Africa: a prospective observational cohort study. Glob Health Res Policy 2018; 3:2. [PMID: 29372186 PMCID: PMC5765667 DOI: 10.1186/s41256-017-0057-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/14/2017] [Indexed: 12/17/2022] Open
Abstract
Background Current practice in the Western Cape region of South Africa is to discharge newborns born in-hospital within 24 h following uncomplicated vaginal delivery and two days after caesarean section. Mothers are instructed to bring their newborn to a clinic after discharge for a health assessment. We sought to determine the rate of newborn follow-up visits and the potential barriers to timely follow-up. Methods Mother-newborn dyads at Tygerberg Hospital in Cape Town, South Africa were enrolled from November 2014 to April 2015. Demographic data were obtained via questionnaire and medical records. Mothers were contacted one week after discharge to determine if they had brought their newborns for a follow-up visit, and if not, the barriers to follow-up. Factors associated with follow-up were analyzed using logistic regression. Results Of 972 newborns, 794 (82%) were seen at a clinic for a follow-up visit within one week of discharge. Mothers with a higher education level or whose newborns were less than 37 weeks were more likely to follow up. The follow-up rate did not differ based on hospital length of stay. Main reported barriers to follow-up included maternal illness, lack of money for transportation, and mother felt follow-up was unnecessary because newborn was healthy. Conclusions Nearly 4 in 5 newborns were seen at a clinic within one week after hospital discharge, in keeping with local practice guidelines. Further research on the outcomes of this population and those who fail to follow up is needed to determine the impact of postnatal healthcare policy.
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Affiliation(s)
| | - KaWing Cho
- 2Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA USA
| | - Charles Okwundu
- 3Centre for Evidence Based Healthcare, Stellenbosch University, Cape Town, South Africa
| | - Abiola Olowoyeye
- 2Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA USA
| | - Leonidas Ndayisaba
- 4Department of Respiratory Intensive Care, Groote Schuur Hospital, Cape Town, South Africa
| | - Sanjay Chand
- 5Division of Hospital Medicine, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS 94, Los Angeles, CA 90027 USA
| | - Mark H Corden
- 5Division of Hospital Medicine, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS 94, Los Angeles, CA 90027 USA.,6Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
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Pertile R, Pavanello L, Soffiati M, Manica L, Piffer S. Length of stay for childbirth in Trentino (North-East of Italy): the impact of maternal characteristics and organizational features of the maternity unit on the probability of early discharge of healthy, term infants. Eur J Pediatr 2018; 177:155-159. [PMID: 29116396 DOI: 10.1007/s00431-017-3035-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED Early discharge (ED) of healthy term infants has become a common practice due to current social and economic needs. The primary objective of the present study was to evaluate trends in early discharge of healthy term neonates (≥ 37 gestational weeks) by delivery method (cesarean and vaginal) in maternity units in the Province of Trento. The secondary objective was to identify the socio-demographic characteristics (including the area of residence and distance from the designated hospital) and clinical characteristics of mothers whose infants were discharged early. This retrospective study reviewed records of live births from 2006 to 2016, for a total of 45, 314 healthy term infants. The trend for ED grew significantly during the period 2006-2016, for both cesarean and vaginal deliveries. The multiple logistic regression analysis shows how the determinants of ED are maternal age, birth order, citizenship of mother, maternal smoking, maternal employment status, and the number of births at the hospital on the day of birth. CONCLUSION The post-partum length of stay should be adjusted based on the characteristics and needs of the mother-infant dyad, identifying the criteria for safe discharge. In Trento, various procedures and programs are becoming more uniform today with the intention to provide family assistance service. What is Known: • Admission for childbirth is one of the primary causes of hospitalization in industrialized countries. • The length of stay for childbirth has been steadily declining in recent decades, with the aim of reducing costs while also demedicalizing pregnancy. What is New: • A higher rate of early discharge (ED) was recorded for neonates of women having foreign citizenship, < 30 years, pluriparous, smoked during pregnancy, housewife, and, if emplyed, entrepreneurs, self-employed professionals or managers. • ED was more common when the new mother gave birth on a day in which there was a higher number of births at the hospital, indicating overcrowding in the maternity unit.
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Affiliation(s)
- Riccardo Pertile
- Clinical and Evaluative Epidemiology Department, Trento Health Service, Viale Verona, 38123, Trento, Italy.
| | - Lucia Pavanello
- Neonatal Unit, Trento Health Service, Largo Medaglie d'Oro 9, 38122, Trento, Italy
| | - Massimo Soffiati
- Neonatal Unit, Trento Health Service, Largo Medaglie d'Oro 9, 38122, Trento, Italy
| | - Laura Manica
- Maternal and child health clinic of Rovereto, Trento Health Service, Via San Giovanni Bosco 10, 38068, Rovereto, TN, Italy
| | - Silvano Piffer
- Clinical and Evaluative Epidemiology Department, Trento Health Service, Viale Verona, 38123, Trento, Italy
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Abstract
PURPOSE OF REVIEW The review highlights the shift from prescribed length of stay (LOS) to mother-infant dyad readiness as the basis for making discharge decisions for healthy term newborns. We describe the components of readiness that should be considered in making the decision, focusing on infant clinical readiness, and maternal and familial readiness. RECENT FINDINGS Although the Newborns' and Mothers' Health Protection Act of 1996 aimed to protect infants and mothers by establishing a minimum LOS, the American Academy of Pediatrics 2015 policy on newborn discharge acknowledges the shift from LOS-based to readiness-based discharge decision-making. Healthcare providers must consider a variety of infant and maternal characteristics in determining the appropriate time to discharge a dyad, and mothers should be actively involved in the decision-making process. Criteria for infant clinical readiness include the following: establishment of effective feeding, evaluation of jaundice risk, review and discussion of infant and household vaccination status, obtainment of specimen for metabolic screening, tests of hearing ability, assessment of sepsis risk factors, screening for congenital heart disease, and evaluation of parental knowledge about infant safety measures. Important consideration should also be given to the mother's sociodemographic vulnerabilities, maternal confidence and perception of discharge readiness, and availability of postdischarge care continuity. SUMMARY The timing of newborn discharge should be a joint decision made by the mother and healthcare providers based on readiness. The decision should consider the infant's health status, the mother's health status, the mother's perception of readiness, and the availability of social and familial support for the mother and infant. Accessible and comprehensive support postdischarge is also important for helping infants achieve optimal health outcomes.
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Chung EK, Gable EK, Golden WC, Hudson JA, Hackman NM, Andrews JP, Jackson DS, Beavers JB, Mirchandani DR, Kellams A, Krevitsky ME, Monroe K, Madlon-Kay DJ, Stratbucker W, Campbell D, Collins J, Rauch D. Current Scope of Practice for Newborn Care in Non-Intensive Hospital Settings. Hosp Pediatr 2017; 7:471-482. [PMID: 28694290 DOI: 10.1542/hpeds.2016-0206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Esther K Chung
- Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania and Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware;
| | - E Kaye Gable
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina and Cone Health, Greensboro, North Carolina
| | - W Christopher Golden
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer A Hudson
- Department of Pediatrics, Greenville Health System, Greenville, South Carolina
| | - Nicole M Hackman
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jennifer P Andrews
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - DeeAnne S Jackson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica B Beavers
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Dipti R Mirchandani
- Department of Pediatrics, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York and Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Ann Kellams
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Meredith E Krevitsky
- Department of Pediatrics, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York and Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Kimberly Monroe
- Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital and University of Michigan, Ann Arbor, Michigan
| | - Diane J Madlon-Kay
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - William Stratbucker
- Department of Pediatrics, Michigan State University and Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Deborah Campbell
- Department of Pediatrics, Albert Einstein College of Medicine, New York, New York and Children's Hospital at Montefiore, Bronx, New York
| | - Jolene Collins
- Department of Pediatrics, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California; and
| | - Daniel Rauch
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Elmhurst, New York
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McGowan EC, Du N, Hawes K, Tucker R, O'Donnell M, Vohr B. Maternal Mental Health and Neonatal Intensive Care Unit Discharge Readiness in Mothers of Preterm Infants. J Pediatr 2017; 184:68-74. [PMID: 28237375 DOI: 10.1016/j.jpeds.2017.01.052] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/14/2016] [Accepted: 01/20/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate associations between maternal mental health disorders (MHDs) and discharge readiness for mothers of infants born preterm (<37 weeks). We hypothesized that mothers with a history of MHDs would report decreased perceptions of neonatal intensive care unit (NICU) discharge readiness compared with mothers without a history. STUDY DESIGN Mothers of infants born preterm in the NICU >5 days between 2012 and 2015 and participating in a transition home program completed a discharge readiness questionnaire measuring perceptions of staff support, infant well-being (medical stability), maternal well-being (emotional readiness/competency), and maternal comfort (worry about infant). Greater scores are more optimal (range 0-100). Social workers obtained a history of MHDs. Group comparisons and regression analyses were run to predict decreased scores and maternal discharge readiness. RESULTS A total of 37% (315/850) of mothers reported a MHD. They were more likely to be white (64% vs 55% P = .05), single (64% vs 45% P ≤ .001), on Medicaid (61% vs 50% P = .002), and less likely to be non-English speaking (10% vs 22%, P ≤ .001). Mothers with MHD perceived less NICU support (92 ± 13 vs 94 ± 12, P = .005), less emotional readiness for discharge (78 ± 17 vs 81 ± 14, P = .04), and lower family cohesion (81 ± 24 vs 86 ± 19, P = .02) compared with mothers without MHD. Regression modeling (OR; CI) indicated that maternal history of MHDs predicted mother's decreased perception of infant well-being (1.56; 1.05-2.33) and her own well-being (1.99; 1.45-2.8) at discharge. CONCLUSION One-third of mothers reported a history of MHDs. This vulnerable group perceive themselves as less ready for discharge home with their infant, indicating an unmet need for provision of enhanced transition services.
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Affiliation(s)
- Elisabeth C McGowan
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Providence, RI.
| | - Nan Du
- Yale New Haven Children's Hospital, New Haven, CT
| | - Katheleen Hawes
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Providence, RI; College of Nursing, University of Rhode Island, Kingston, RI
| | - Richard Tucker
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Providence, RI
| | - Melissa O'Donnell
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Providence, RI
| | - Betty Vohr
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Providence, RI
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Rite Gracia S, Pérez Muñuzuri A, Sanz López E, Leante Castellanos JL, Benavente Fernández I, Ruiz Campillo CW, Sánchez Redondo MD, Sánchez Luna M. Criteria for hospital discharge of the healthy term newborn after delivery. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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50
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Rite Gracia S, Pérez Muñuzuri A, Sanz López E, Leante Castellanos JL, Benavente Fernández I, Ruiz Campillo CW, Sánchez Redondo MD, Sánchez Luna M. [Criteria for hospital discharge of the healthy term newborn after delivery]. An Pediatr (Barc) 2016; 86:289.e1-289.e6. [PMID: 27746077 DOI: 10.1016/j.anpedi.2016.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/22/2016] [Indexed: 11/28/2022] Open
Abstract
Criteria for newborn hospital discharge have to include physiological stability and family competence to provide newborn care at home. In this document, the Committee of Standards of the Spanish Society of Neonatology reviews the minimum criteria to be met before hospital discharge of a term newborn infant. We include a review of hospital discharge criteria for the late preterm infants, as these infants are often not hospitalised and remain with their mother after birth. A shortened hospital stay (less than 48h after delivery) for healthy term newborns can be considered, but it is not appropriate for every mother and newborn. Newborn infants discharged before 48h of age, should be examined within 3-4 days of life.
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