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Bitew DA, Diress M, Gela YY, Belay DG, Kibret AA, Chilot D, Sinamaw D, Seid MA, Seid AM, Simegn W, Eshetu HB, Andualem AA. Determinants of early discharge after birth among mothers delivered vaginally at health facilities: further analysis of the Ethiopian demographic health survey. BMC Public Health 2023; 23:2128. [PMID: 37904085 PMCID: PMC10617109 DOI: 10.1186/s12889-023-16922-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: 10/28/2022] [Accepted: 10/06/2023] [Indexed: 11/01/2023] Open
Abstract
INTRODUCTION The majority of maternal and newborn deaths take place during the first few hours and days after birth and thus postnatal contacts should begin as early as possible, especially within the first 24 h, then again within two to three days after delivery. Globally, early postnatal discharge has increased over the past 50 years and currently too. Even if Ethiopia has very low PNC coverage, there is no evidence on who is discharged early. Hence, the aim of this study was to determine the magnitude and the predictors for early postnatal discharge in Ethiopia. METHODS This study was based on the secondary data analysis using the Ethiopian Demographic and Health survey (EDHS) 2016 data set. The weighted sample of 2,225 delivered mothers were included for the final analysis. The model was best fitted as assessed by Hosmer-Lemeshow test (p value = 0.1988). The variables with P-value ≤ 0.2 in the bi- variable binary logistic regression analysis were included in to the multi-variable binary logistic regression analysis. The Adjusted Odds Ratio (AOR) with 95% confidence interval (95% CI) was computed to assess the strength of association between the outcome and independent variables. The variables with a P-value of less than 0.05 in the multi-variable binary logistic regression analysis were declared as statistically significant predictors of the outcome variable. RESULT The overall magnitude of early discharge was 70.41% (CI: 68.48, 72.30). Residence (rural; AOR: 0.61, 95% CI: 0.46, 0.80), educational status (No education; AOR: 1.87, 95% CI: 1.19, 2.94), religion (Muslim; AOR: 0.69, 95% CI: 0.55, 0.87, Others; AOR: 0.24, 95% CI: 0.10, 0.57), wealth index (Poor; AOR: 0.77; 95% CI: 0.59, 0.99), marital status (Not married; AOR: 0.29; 95% CI: 0.13, 0.67), ANC visits (No ANC visits; AOR: 0.63; 95% CI: 0.46,0.86), parity (3rd parity; AOR: 1.48; 95% CI: 1.03, 2.11), and size of the child (larger size; AOR: 0.63;95% CI: 0.50,0.79, (smaller size; AOR: 0.72; 95% CI: 0.56,0.92) were independent determinants of early discharge. CONCLUSION A substantial proportions of mothers in Ethiopia had been discharged early (before 24 h). Residence, education, wealth index, religion, marital status, ANC follow up, parity and size of the child were predictors of early discharge. Adequate hospital stay should be promoted. Since the early discharge in Ethiopia is very high, home based postnatal visit should be strengthened focusing the identified predictors.
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Affiliation(s)
- Desalegn Anmut Bitew
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia.
| | - Mengistie Diress
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Yibeltal Yismaw Gela
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Anteneh Ayelign Kibret
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Dagmawi Chilot
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
- College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Deresse Sinamaw
- Department of Biomedical Science, Debre Markos University, P. O. Box 269, Debre Markos, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Human Physiology, Department of Biomedical Science, College of Health Sciences, Debre Tabor University, P. O. Box: 272, Debre Tabor, Ethiopia
| | | | - Wudneh Simegn
- Department of Social and Administrative Pharmacy, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Education and Behavioral Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
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Aune A, Vartdal G, Jimenez Diaz G, Gierman LM, Bergseng H, Darj E. Iterative Development, Validation, and Certification of a Smartphone System to Assess Neonatal Jaundice: Development and Usability Study. JMIR Pediatr Parent 2023; 6:e40463. [PMID: 36853753 PMCID: PMC10015352 DOI: 10.2196/40463] [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: 06/28/2022] [Revised: 12/16/2022] [Accepted: 01/16/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Medical device development is an area facing multiple challenges, resulting in a high number of products not reaching the clinical setting. Neonatal hyperbilirubinemia, manifesting as neonatal jaundice (NNJ), is an important cause of newborn morbidity and mortality. It is important to identify infants with neonatal hyperbilirubinemia at an early stage, but currently there is a lack of tools that are both accurate and affordable. OBJECTIVE This study aimed to develop a novel system to assess the presence of NNJ. The device should provide accurate results, be approved as a medical device, be easy to use, and be produced at a price that is affordable even in low-resource settings. METHODS We used an iterative approach to develop a smartphone-based system to detect the presence of NNJ. We performed technical development, followed by clinical and usability testing in parallel, after which we initiated the regulatory processes for certification. We updated the system in each iteration, and the final version underwent a clinical validation study on healthy term newborns aged 1 to 15 days before all documentation was submitted for conformity assessment to obtain Conformité Européenne (CE) certification. We developed a system that incorporates a smartphone app, a color calibration card, and a server. RESULTS Three iterations of the smartphone-based system were developed; the final version was approved as a medical device after complying with Medical Device Regulation guidelines. A total of 201 infants were included in the validation study. Bilirubin values using the system highly correlated with total serum or plasma bilirubin levels (r=0.84). The system had a high sensitivity (94%) to detect severe jaundice, defined as total serum or plasma bilirubin >250 µmol/L, and maintained a high specificity (71%). CONCLUSIONS Our smartphone-based system has a high potential as a tool for identifying NNJ. An iterative approach to product development, conducted by working on different tasks in parallel, resulted in a functional and successful product. By adhering to the requirements for regulatory approval from the beginning of the project, we were able to develop a market-ready mobile health solution.
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Affiliation(s)
- Anders Aune
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Picterus AS, Trondheim, Norway
| | | | - Gabriela Jimenez Diaz
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Picterus AS, Trondheim, Norway
| | | | - Håkon Bergseng
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neonatology, St.Olav Hospital, Trondheim, Norway
| | - Elisabeth Darj
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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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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Chiao SS, Razzaq KK, Sheeran JS, Forkin KT, Spangler SN, Knio ZO, Kellams AL, Tiouririne M. Effect of enhanced recovery after surgery for elective cesarean deliveries on neonatal outcomes. J Perinatol 2022; 42:1283-1287. [PMID: 35013588 DOI: 10.1038/s41372-021-01309-x] [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] [Received: 08/20/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the impact of initiation of an enhanced recovery after cesarean delivery (ERAC) protocol for elective cesarean delivery (CD) on neonatal outcomes. STUDY DESIGN We performed a retrospective analysis of elective CD at ≥39 weeks gestational age between September 2014 and August 2018 at a single institution before and after ERAC protocol implementation. Our primary outcome was composite neonatal complication rate and secondary outcome was rate of breastfeeding. We performed univariate analyses to detect differences in outcomes between the pre-ERAC and post-ERAC groups. RESULTS We included 362 neonates born via elective CD before (n = 135) and after (n = 227) ERAC implementation. The post-ERAC group experienced fewer composite neonatal complications (33.0% vs. 47.4%, p = 0.009) and greater breastfeeding rates (80.2% vs. 67.4%, p = 0.009) compared to the pre-ERAC group. CONCLUSION ERAC protocol implementation does not negatively impact neonates and may benefit both mother and baby.
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Affiliation(s)
- Sunny S Chiao
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA.
| | - Khadija K Razzaq
- University of Virginia School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Jessica S Sheeran
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Katherine T Forkin
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Sarah N Spangler
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Ziyad O Knio
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Ann L Kellams
- Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA
| | - Mohamed Tiouririne
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
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Wyatt S, Aldridge P, Ross S, Narayanan S, Zuccolo L. The Frequency of Infant-Feeding Presentations at English Emergency Departments During the SARS-CoV-2 Pandemic: A Nation-Wide Electronic Health Records Study. Cureus 2022; 14:e27645. [PMID: 36072185 PMCID: PMC9439262 DOI: 10.7759/cureus.27645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/05/2022] Open
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Pohjanpää M, Ojala R, Luukkaala T, Gissler M, Tammela O. Association of early discharge with increased likelihood of hospital readmission in first four weeks for vaginally delivered neonates. Acta Paediatr 2022; 111:1144-1156. [PMID: 35152473 PMCID: PMC9306497 DOI: 10.1111/apa.16290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/01/2022] [Accepted: 02/11/2022] [Indexed: 11/29/2022]
Abstract
Aim The main aim was to determine whether hospital readmission rates by 28 days of age are elevated with early discharge (ED) in Finland. We sought to identify the causes and predictors of ED, readmission rates, admissions to the intensive care unit (ICU) and death. Methods The data of 333,321 infants were retrieved from nationwide registers. Vaginally delivered single infants at gestational ages (GAs) of ≥37+0, born in 2008–2015 and treated in any maternity ward in Finland, were included. ED was defined as discharge on the day of birth or after one night stay on the maternity ward. Results During the study period, the ED and hospital readmission rates increased. Low‐risk infants and those born in high population‐density areas were more likely to be discharged early. ED predicted hospital readmission but not ICU admission or death. The most common reason for readmission was jaundice, followed by infection. ED seemed not to predict severe cardiologic problems. Rather than ED, being born at 38+0–38+6 weeks’ GA significantly predicted ICU admission or death. Conclusion Early discharge seems to be associated with increased hospital readmission. Birth at 38+0–38+6 weeks’ GA was a significant predictor of ICU admission or death, as opposed to early discharged infants.
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Affiliation(s)
- Maria Pohjanpää
- Department of Paediatrics Tampere University Hospital Tampere Finland
| | - Riitta Ojala
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Tampere Centre for Child Health Research Tampere University Tampere Finland
| | - Tiina Luukkaala
- Research, Innovation and Development Centre Tampere University Hospital Tampere Finland
- Health Sciences Faculty of Social Sciences University of Tampere Tampere Finland
| | - Mika Gissler
- Information Services Department THL Finnish Institute for Health and Welfare Helsinki Finland
- Research Centre for Child Psychiatry University of Turku Turku Finland
- Region Stockholm Academic Primary Health Care Centre Stockholm Sweden
- Department of Molecular Medicine and Surgery Karolinska Institute Stockholm Sweden
| | - Outi Tammela
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Tampere Centre for Child Health Research Tampere University Tampere Finland
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Kardum D, Serdarušić I, Biljan B, Šantić K, Živković V. Readmission of late preterm and term neonates in the neonatal period. Clinics (Sao Paulo) 2022; 77:100005. [PMID: 35168009 PMCID: PMC8903804 DOI: 10.1016/j.clinsp.2022.100005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/30/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine the incidence of hospital readmissions in late preterm and term neonates, the most common reasons for readmission, and analyze the risk factors for readmission in the neonatal period. METHODS Newborn infants admitted to a well-baby nursery ≥ 36 weeks gestation were included in this retrospective cohort study. Data for all infants born in a 3-year period and readmitted in the first 28 days of life were analyzed. Indication for readmission was one diagnosed during initial workup in the pediatric emergency room visit before readmission. RESULTS The final cohort consisted of 5408 infants. The readmission rate was 4.0% (219/5408). Leading readmission causes were respiratory tract infection (29.58%), jaundice (13.70%), and urinary tract infection (9.59%). The mean ± SD age of readmitted infants was 13.3 ± 7.1 days. The mean ± SD treatment duration of treatment was 5.5 ± 3.0 days. In the multivariate regression analysis, infants that were during the initial hospitalization transferred to special care/NICU had a lower chance of readmission during the neonatal period (p = 0.04, OR = 0.23, 95% CI 0.06-0.93). Infants with mothers aged from 19-24 years had a higher risk of readmission (p = 0.005, OR = 1.62, 95% CI 1.16-2.26). CONCLUSIONS Finding that infants that were during the initial hospitalization transferred to special care or a NICU setting were less likely to require hospitalization in the neonatal period is an interesting one. Further research into how different approach in these settings reduce the risk of readmission is necessary.
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Affiliation(s)
- Darjan Kardum
- Department of Pediatrics, University Hospital Osijek, Osijek, Croatia; School of Medicine, University J. J. Strossmayer Osijek, Osijek, Croatia.
| | - Ivana Serdarušić
- Department of Pediatrics, University Hospital Osijek, Osijek, Croatia; School of Medicine, University J. J. Strossmayer Osijek, Osijek, Croatia
| | - Borna Biljan
- Department of Pediatrics, University Hospital Osijek, Osijek, Croatia; School of Medicine, University J. J. Strossmayer Osijek, Osijek, Croatia
| | - Krešimir Šantić
- Department of Pediatrics, University Hospital Osijek, Osijek, Croatia; School of Medicine, University J. J. Strossmayer Osijek, Osijek, Croatia
| | - Vinko Živković
- Department of Pediatrics, University Hospital Osijek, Osijek, Croatia
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Hanin EA, Rayan H, Hani T, Taleb J, Dany AH, Lama C. Breastfeeding and Readmission for Hyperbilirubinemia in Late Preterm and Term Infants in Beirut, Lebanon. Indian Pediatr 2021. [DOI: 10.1007/s13312-022-2472-y] [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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Noddin K, Bradley D, Wolfberg A. Delivery Outcomes During the COVID-19 Pandemic as Reported in a Pregnancy Mobile App: Retrospective Cohort Study. JMIR Pediatr Parent 2021; 4:e27769. [PMID: 34509975 PMCID: PMC8491643 DOI: 10.2196/27769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/11/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has presented obstacles for providers and patients in the maternal health care setting, causing changes to many pregnant women's birth plans, as well as abrupt changes in hospital labor and delivery policies and procedures. Few data exist on the effects of the COVID-19 pandemic on the maternal health care landscape at the national level in the United States. OBJECTIVE The aim of this study is to assess the incidence of key obstetrics outcomes (preterm delivery, Cesarean sections, and home births) and length of hospital stay during the COVID-19 pandemic as compared to the 6 months prior. METHODS We conducted a retrospective cohort study of women aged 18-44 years in the United States who delivered between October 1, 2019, and September 30, 2020, had singleton deliveries, and completed a birth report in the Ovia Pregnancy mobile app. Women were assigned to the prepandemic cohort if they delivered between October 2019 and March 2020, and the pandemic cohort if they delivered between April and September 2020. Gestational age at delivery, delivery method, delivery facility type, and length of hospital stay were compared. RESULTS A total of 304,023 birth reports were collected, with 152,832 (50.26%) in the prepandemic cohort and 151,191 (49.73%) in the pandemic cohort. Compared to the prepandemic cohort, principal findings indicate a 5.67% decrease in preterm delivery rates in the pandemic cohort (P<.001; odds ratio [OR] 0.94, 95% CI 0.91-0.96), a 30.0% increase in home birth rates (P<.001; OR 1.3, 95% CI 1.23-1.4), and a 7.81% decrease in the average hospital length of stay postdelivery (mean 2.48 days, SD 1.35). There were no overall changes in Cesarean section rates between cohorts, but differences were observed between age, race, and ethnicity subgroups. CONCLUSIONS Results suggest a need for continuous monitoring of maternal health trends as the COVID-19 pandemic progresses and underline the important role of digital data collection, particularly during the pandemic.
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Affiliation(s)
| | | | - Adam Wolfberg
- Ovia Health, Boston, MA, United States
- Cambridge Hospital, Cambridge, MA, United States
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Page D, Gilroy M, Joseph R, van der Meij B. Pasteurised donor human milk audit: What is happening in the neonatal critical care unit? J Paediatr Child Health 2021; 57:998-1002. [PMID: 33524194 DOI: 10.1111/jpc.15361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 02/03/2023]
Abstract
AIM Human milk with fortification, providing additional energy, protein and micronutrients, is considered the optimal form of nutrition for preterm infants as it provides protection against infections and improves outcomes. Mothers' own milk (MOM) is the preferred choice, however in situations where MOM is insufficient or contraindicated; Pasteurised donor human milk (PDHM) is the preferred alternative. This study aimed to identify whether PDHM during neonatal critical care unit (NCCU) admission is associated with discharge nutrition in preterm infants. METHODS A retrospective observational cohort study was conducted over a 12-month period in 2017. This included all inborn infants admitted to the NCCU with gestational age ≤ 28 weeks or ≤ 1000 g birthweight, who survived until discharge. Multivariate logistic models were used to detect the association between study groups (PDHM vs. No PDHM) and discharge nutrition. RESULTS Seventy-seven infants were included; 35 infants received PDHM during admission. At discharge, infants who received PDHM were significantly more likely to be on infant formula (IF) (86%) than infants who did not receive PDHM (26%). In contrast, infants who did not receive PDHM (No PDHM) were significantly more likely to be receiving MOM exclusively at discharge (74%), than those who did receive PDHM (14%). The odds of an infant being discharged on IF were 16.91 times higher if they received PDHM. CONCLUSION In this study, infants born at ≤28 weeks or ≤ 1000 g who received PDHM were more likely to receive IF at NCCU discharge than infants who did not receive PDHM.
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Affiliation(s)
- Denise Page
- Department of Dietetics and Food Services, Mater Hospital Brisbane, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Melissa Gilroy
- Department of Dietetics and Food Services, Mater Hospital Brisbane, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Ria Joseph
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Barbara van der Meij
- Department of Dietetics and Food Services, Mater Hospital Brisbane, Brisbane, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Khasawneh W, Alyousef R, Akawi Z, Al-Dhoon A, Odat A. Maternal and Perinatal Determinants of Late Hospital Discharge Among Late Preterm Infants; A 5-Year Cross-Sectional Analysis. Front Pediatr 2021; 9:685016. [PMID: 34222151 PMCID: PMC8242188 DOI: 10.3389/fped.2021.685016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Although late preterm infants (LPIs) account for the majority of preterm births, they are mistakenly labelled and treated as "near term." Whether longer initial hospital stay improves their outcomes and lowers readmission is controversial. The aim of this study is to identify maternal and perinatal factors associated with longer hospital stay and to assess the rate of readmission. Methods: The medical records of LPIs delivered at an academic center in Jordan over a 5-year period were reviewed. They were divided according to their initial hospital stay into: Early discharge group (ED, ≤ 3 days) and late discharge group (LD, > 3 days). Maternal and perinatal factors associated with > 3-day hospital stay were reported. The rate of readmission was compared between both groups. Results: 2236 LPIs were included in the analysis representing 13% of total births and 81% of premature births. LD group constituted 54%. A thousand two hundred forty three (56%) required admission to NICU. Factors associated with longer hospital stay included maternal prolonged rupture of membranes (AOR 1.9, 95% C.I 1.5, 2.4, p 0.000), C-section delivery (AOR 2.4, 95% C.I 1.9, 3, p 0.001), <35-week gestation (AOR 3.8, 95% C.I 2.6, 5, p 0.000), small-for-gestational age (AOR 1.9, 95% C.I 1.1, 3.8, p 0.03), birthweight <2,500 g (AOR 1.3, 95% C.I 1.1, 1.6, p 0.02), NICU admission (AOR 6.3, 95% C.I 3.4, 11.5, p 0.000), RDS (AOR 2.3, 95% C.I 1.5, 3.6, p 0.005), surfactant therapy (AOR 5, 95% C.I 1.9, 13.5, p 0.001), use of CPAP (AOR 1.7, 95% C.I 1.2, 2.2, p 0.001), jaundice (AOR 11.2, 95% C.I 7.7, 16.2, p 0.000), and sepsis (AOR 10.3, 95% C.I 4.8, 22, p 0.000). Readmission rate was 19% among the LD group and 13% among the ED group. Conclusion: LPIs are at high risk for developing prematurity-related morbidities and the duration of their initial hospital stay can be anticipated based on certain predisposing maternal and perinatal factors. Late discharge of LPIs does not lower the rate of readmission.
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Affiliation(s)
- Wasim Khasawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rahaf Alyousef
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Zuhour Akawi
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Areen Al-Dhoon
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahlam Odat
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Glassman ME, Diamond R, Won SK, Johal J, Sirota DR. Newborn Clinic: A Novel Model to Provide Timely, Comprehensive Care to Newborns Following Nursery Discharge. Clin Pediatr (Phila) 2020; 59:1233-1239. [PMID: 33000662 DOI: 10.1177/0009922820944400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ensuring safe and timely follow-up after well baby nursery (WBN) discharge is an ongoing challenge. This study demonstrates the efficacy of a novel model for follow-up, the Newborn Clinic (NBC), in reducing time to outpatient follow-up after WBN discharge. Our retrospective chart review of 17 952 newborns found that time to follow-up visit decreased significantly following NBC establishment. Emergency department visits, a marker of infant morbidity, were slightly increased in the post-establishment cohort. There was no difference, however, in hospital readmissions. Analysis within the post-establishment cohort showed that newborns with jaundice, a high-risk group, were much more likely to have early follow-up if their visit was scheduled with NBC. Our study demonstrates that NBC is an effective model for decreasing time from WBN discharge to follow-up visit. It should be considered as an initiative to run concurrently with expedited newborn discharge initiatives so that safe follow-up need not be sacrificed.
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Affiliation(s)
- Melissa E Glassman
- Department of Pediatrics, Columbia University, New York, NY, USA.,Department of Pediatrics, New York Presbyterian Hospital, New York, NY, USA
| | - Rebekah Diamond
- Department of Pediatrics, Columbia University, New York, NY, USA.,Department of Pediatrics, New York Presbyterian Hospital, New York, NY, USA
| | - Sharon K Won
- Department of Pediatrics, New York Presbyterian Hospital, New York, NY, USA
| | - Jasmyn Johal
- Columbia University College of Physicians and Surgeons, Institute of Human Nutrition, New York, NY, USA
| | - Dana R Sirota
- Department of Pediatrics, Columbia University, New York, NY, USA.,Department of Pediatrics, New York Presbyterian Hospital, New York, NY, USA
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13
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Anagnostou A, Schrod L, Jochim J, Enenkel J, Krill W, Schlößer RL. Morbidity in Newborns Readmitted Into a Hospital After Discharge From a Maternity Unit During the First 28 Days of Their Lives - Results From the Rhine-Main Area, Germany. Z Geburtshilfe Neonatol 2020; 225:161-166. [PMID: 32767292 DOI: 10.1055/a-1205-1517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The neonatal period can be associated with a multitude of medical and social problems. Little is known about the reasons that lead to neonatal readmissions in a pediatric hospital and their individual outcomes. OBJECTIVE To record the diagnosis of neonatal admissions in a pediatric hospital after discharge from a maternity unit. Predictive parameters are to be identified and a possible trend over the years is to be examined. METHODS The medical history of newborns admitted to a pediatric hospital in the Rhine-Main area from 01/01/2004 to 31/12/2013 was retrospectively analyzed based on provided medical files. RESULTS The data of 2851 newborns was recorded. 72% of the patients were delivered by vaginal birth. During the period under examination, there was a certain fluctuation although no significant trend in the number of admissions per year (p=0.062). The most frequent primary diagnoses were jaundice (27%), newborn infection (12.4%), and feeding problems (12.3%). Exclusively breastfed newborns had fewer feeding problems than newborns with a mixed or purely formula diets (p < 0.001). CONCLUSIONS The results of this study showed that the hospital readmissions of newborns throughout the years did not increase. Unfortunately, owing to the retrospective character of the study, it is not possible to make a clear statement as to whether hospitalization can be prevented with more intensive preventative measures. A prospective study on this matter is being planned.
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Affiliation(s)
- Anastasia Anagnostou
- Department of Neonatology, University Hospital, Goethe University, Frankfurt am Main
| | - Lothar Schrod
- Department of Pediatrics, Hospital Frankfurt Höchst GmbH, Frankfurt am Main
| | - Judith Jochim
- Department of Pediatrics, Sana Klinikum Offenbach GmbH, Offenbach
| | - Jürgen Enenkel
- Department of Pediatrics, Sana Klinikum Offenbach GmbH, Offenbach
| | | | - Rolf Lambert Schlößer
- Department of Neonatology, University Hospital, Goethe University, Frankfurt am Main
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14
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Grylka-Baeschlin S, Iglesias C, Erdin R, Pehlke-Milde J. Evaluation of a midwifery network to guarantee outpatient postpartum care: a mixed methods study. BMC Health Serv Res 2020; 20:565. [PMID: 32571320 PMCID: PMC7310082 DOI: 10.1186/s12913-020-05359-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 05/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The necessity of outpatient postpartum care has increased due to shorter hospital stays. In a health care system, where postpartum care after hospital discharge must be arranged by families themselves, this can be challenging for those experiencing psychosocial disadvantages. Therefore, we compared characteristics of users of a midwifery network which referred women to outpatient postpartum care providers with those of women organising care themselves. Additionally, we investigated benefits of the network for women and health professionals. METHODS Evaluation of the services of a midwifery network in Switzerland. We combined quantitative secondary analysis of routine data of independent midwives with qualitative telephone interviews with users and a focus group with midwives and nurses. Descriptive statistics and logistic regression modelling were done using Stata 13. Content analysis was applied for qualitative data. RESULTS Users of the network were more likely to be: primiparas (OR 1.52, 95% CI [1.31-1.75, p < 0.001]); of foreign nationality (OR 2.36, 95% CI [2.04-2.73], p < 0.001); without professional education (OR 1.89, 95% CI [1.56-2.29] p < 0.001); unemployed (OR 1.28, 95% CI [1.09-1.51], p = 0.002) and have given birth by caesarean section (OR 1.38, 95% CI [1.20-1.59], p < 0.001) compared to women organising care themselves. Furthermore, users had cumulative risk factors for vulnerable transition into parenthood more often (≥ three risk factors: 4.2% vs. 1.5%, p < 0.001). Women appreciate the services provided. The collaboration within the network facilitated work scheduling and the better use of resources for health professionals. CONCLUSIONS The network enabled midwives and nurses to reach families who might have struggled to organise postpartum care themselves. It also facilitated the work organisation of health professionals. Networks therefore provide benefits for families and health professionals.
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Affiliation(s)
- Susanne Grylka-Baeschlin
- Research Unit for Midwifery Science, ZHAW Zurich University of Applied Sciences, Technikumstr. 81, CH-8401, Winterthur, Switzerland.
| | - Carolina Iglesias
- Familystart Zurich, Thurgauerstrasse 39, CH-8050, Zurich, Switzerland
| | - Rebekka Erdin
- Research Unit for Midwifery Science, ZHAW Zurich University of Applied Sciences, Technikumstr. 81, CH-8401, Winterthur, Switzerland.,Familystart Zurich, Thurgauerstrasse 39, CH-8050, Zurich, Switzerland
| | - Jessica Pehlke-Milde
- Research Unit for Midwifery Science, ZHAW Zurich University of Applied Sciences, Technikumstr. 81, CH-8401, Winterthur, Switzerland
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15
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Zhou H, Roberts PA, Dhaliwal SS, Della PR. Risk factors associated with paediatric unplanned hospital readmissions: a systematic review. BMJ Open 2019; 9:e020554. [PMID: 30696664 PMCID: PMC6352831 DOI: 10.1136/bmjopen-2017-020554] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 09/21/2018] [Accepted: 10/23/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To synthesise evidence on risk factors associated with paediatric unplanned hospital readmissions (UHRs). DESIGN Systematic review. DATA SOURCE CINAHL, EMBASE (Ovid) and MEDLINE from 2000 to 2017. ELIGIBILITY CRITERIA Studies published in English with full-text access and focused on paediatric All-cause, Surgical procedure and General medical condition related UHRs were included. DATA EXTRACTION AND SYNTHESIS Characteristics of the included studies, examined variables and the statistically significant risk factors were extracted. Two reviewers independently assessed study quality based on six domains of potential bias. Pooling of extracted risk factors was not permitted due to heterogeneity of the included studies. Data were synthesised using content analysis and presented in narrative form. RESULTS Thirty-six significant risk factors were extracted from the 44 included studies and presented under three health condition groupings. For All-cause UHRs, ethnicity, comorbidity and type of health insurance were the most frequently cited factors. For Surgical procedure related UHRs, specific surgical procedures, comorbidity, length of stay (LOS), age, the American Society of Anaesthesiologists class, postoperative complications, duration of procedure, type of health insurance and illness severity were cited more frequently. The four most cited risk factors associated with General medical condition related UHRs were comorbidity, age, health service usage prior to the index admission and LOS. CONCLUSIONS This systematic review acknowledges the complexity of readmission risk prediction in paediatric populations. This review identified four risk factors across all three health condition groupings, namely comorbidity; public health insurance; longer LOS and patients<12 months or between 13-18 years. The identification of risk factors, however, depended on the variables examined by each of the included studies. Consideration should be taken into account when generalising reported risk factors to other institutions. This review highlights the need to develop a standardised set of measures to capture key hospital discharge variables that predict unplanned readmission among paediatric patients.
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Affiliation(s)
- Huaqiong Zhou
- General Surgical Ward, Princess Margret Hospital for Children, Perth, Western Australia, Australia
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Pam A Roberts
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | | | - Phillip R Della
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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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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Umbilical cord blood bilirubins, gestational age, and maternal race predict neonatal hyperbilirubinemia. PLoS One 2018; 13:e0197888. [PMID: 29856776 PMCID: PMC5983417 DOI: 10.1371/journal.pone.0197888] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/10/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE No validated biomarker at birth exists to predict which newborns will develop severe hyperbilirubinemia. This study's primary aim was to build and validate a prediction model for severe hyperbilirubinemia using umbilical cord blood bilirubins (CBB) and risk factors at birth in neonates at risk for maternal-fetal blood group incompatibility. This study's secondary aim was to compare the accuracy of CBB to the direct antigen titer. METHODS Inclusion criteria for this prospective cohort study included: ≥35 weeks gestational age, mother with blood type O and/or Rh negative or positive antibody screen, and <24 hours of age. The primary outcome was severe hyperbilirubinemia, defined as phototherapy during the initial hospital stay. Secondary outcomes were a total serum bilirubin concentration >95th and >75th percentile during the initial hospital stay. The predictive performance and accuracy of the two tests (CBB and direct antigen titer) for each outcome was assessed using area under a receiver-operating characteristic curve (AUC), sensitivity, and specificity. RESULTS When compared to neonates who did not receive phototherapy (n = 463), neonates who received phototherapy (n = 36) had a greater mean CBB ± standard deviation (2.5 ± 0.7 vs. 1.6 ± 0.4 mg/dL, p<0.001). For every 0.3 mg/dL increase in CBB, a neonate was 3.20 (95% confidence interval, 2.31-4.45), 2.10 (1.63-2.70), and 3.12 (2.44-3.99) times more likely to receive phototherapy or have a total serum bilirubin concentration >95th and >75th percentile, respectively. The AUC ± standard error (95% confidence interval) for CBB for phototherapy and a total serum bilirubin concentration >95th and >75th percentile was 0.89 ± 0.03 (0.82-0.95), 0.81 ± 0.04 (0.73-0.90), and 0.84 ± 0.02 (0.80-0.89), respectively. However, the AUC for gestational age and maternal Asian race for these outcomes was only 0.55 ± 0.05 (0.45-0.66), 0.66 ± 0.05 (0.56-0.76), and 0.57 ± 0.04 (0.05-0.64), respectively. When the CBB was combined with gestational age and maternal Asian race, the AUC for a total serum bilirubin concentration >95th percentile improved to 0.87 ± 0.03 (0.81-0.92) (p = 0.034 vs. the model with CBB only and p<0.001 vs. the model with clinical risk factors only). In a sub-group of subjects (n = 189), the AUC for the direct antigen titer for phototherapy was 0.64 ± 0.06 (0.52-0.77) with a 52% sensitivity and 77% specificity. In contrast, a CBB cut-point of 1.85 mg/dL was 92% sensitive and 70% specific for phototherapy with an AUC of 0.87 ± 0.04 (0.80-0.95). CONCLUSION CBB, in combination with gestational age and maternal race, may be a useful, non-invasive test to predict shortly after birth which neonates will develop severe hyperbilirubinemia.
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18
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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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19
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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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20
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Nilsson IMS, Strandberg‐Larsen K, Knight CH, Hansen AV, Kronborg H. Focused breastfeeding counselling improves short- and long-term success in an early-discharge setting: A cluster-randomized study. MATERNAL & CHILD NUTRITION 2017; 13:e12432. [PMID: 28194877 PMCID: PMC7082818 DOI: 10.1111/mcn.12432] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/26/2016] [Accepted: 01/09/2017] [Indexed: 11/27/2022]
Abstract
Length of postnatal hospitalization has decreased and has been shown to be associated with infant nutritional problems and increase in readmissions. We aimed to evaluate if guidelines for breastfeeding counselling in an early discharge hospital setting had an effect on maternal breastfeeding self-efficacy, infant readmission and breastfeeding duration. A cluster randomized trial was conducted and assigned nine maternity settings in Denmark to intervention or usual care. Women were eligible if they expected a single infant, intended to breastfeed, were able to read Danish, and expected to be discharged within 50 hr postnatally. Between April 2013 and August 2014, 2,065 mothers were recruited at intervention and 1,476 at reference settings. Results show that the intervention did not affect maternal breastfeeding self-efficacy (primary outcome). However, less infants were readmitted 1 week postnatally in the intervention compared to the reference group (adjusted OR 0.55, 95% CI 0.37, -0.81), and 6 months following birth, more infants were exclusively breastfed in the intervention group (adjusted OR 1.36, 95% CI 1.02, -1.81). Moreover, mothers in the intervention compared to the reference group were breastfeeding more frequently (p < .001), and spend more hours skin to skin with their infants (p < .001). The infants were less often treated for jaundice (p = 0.003) and there was more paternal involvement (p = .037). In an early discharge hospital setting, a focused breastfeeding programme concentrating on increased skin to skin contact, frequent breastfeeding, good positioning of the mother infant dyad, and enhanced involvement of the father improved short-term and long-term breastfeeding success.
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Affiliation(s)
- Ingrid M. S. Nilsson
- The Danish Committee for Health EducationCopenhagenDenmark
- Department of Public Health, Section of NursingAarhus UniversityAarhusDenmark
- Department of Public health, Section of Social MedicineCopenhagen UniversityCopenhagenDenmark
| | | | - Christopher H. Knight
- Institute of Veterinary Clinical and Animal SciencesCopenhagen UniversityCopenhagenDenmark
| | - Anne Vinkel Hansen
- Department of Public health, Section of Social MedicineCopenhagen UniversityCopenhagenDenmark
| | - Hanne Kronborg
- Department of Public Health, Section of NursingAarhus UniversityAarhusDenmark
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Benahmed N, San Miguel L, Devos C, Fairon N, Christiaens W. Vaginal delivery: how does early hospital discharge affect mother and child outcomes? A systematic literature review. BMC Pregnancy Childbirth 2017; 17:289. [PMID: 28877667 PMCID: PMC5588709 DOI: 10.1186/s12884-017-1465-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 08/22/2017] [Indexed: 01/08/2023] Open
Affiliation(s)
- Nadia Benahmed
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Lorena San Miguel
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Carl Devos
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Nicolas Fairon
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Wendy Christiaens
- KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
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22
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Riordan SM, Bittel DC, Le Pichon JB, Gazzin S, Tiribelli C, Watchko JF, Wennberg RP, Shapiro SM. A Hypothesis for Using Pathway Genetic Load Analysis for Understanding Complex Outcomes in Bilirubin Encephalopathy. Front Neurosci 2016; 10:376. [PMID: 27587993 PMCID: PMC4988977 DOI: 10.3389/fnins.2016.00376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/02/2016] [Indexed: 01/18/2023] Open
Abstract
Genetic-based susceptibility to bilirubin neurotoxicity and chronic bilirubin encephalopathy (kernicterus) is still poorly understood. Neonatal jaundice affects 60–80% of newborns, and considerable effort goes into preventing this relatively benign condition from escalating into the development of kernicterus making the incidence of this potentially devastating condition very rare in more developed countries. The current understanding of the genetic background of kernicterus is largely comprised of mutations related to alterations of bilirubin production, elimination, or both. Less is known about mutations that may predispose or protect against CNS bilirubin neurotoxicity. The lack of a monogenetic source for this risk of bilirubin neurotoxicity suggests that disease progression is dependent upon an overall decrease in the functionality of one or more essential genetically controlled metabolic pathways. In other words, a “load” is placed on key pathways in the form of multiple genetic variants that combine to create a vulnerable phenotype. The idea of epistatic interactions creating a pathway genetic load (PGL) that affects the response to a specific insult has been previously reported as a PGL score. We hypothesize that the PGL score can be used to investigate whether increased susceptibility to bilirubin-induced CNS damage in neonates is due to a mutational load being placed on key genetic pathways important to the central nervous system's response to bilirubin neurotoxicity. We propose a modification of the PGL score method that replaces the use of a canonical pathway with custom gene lists organized into three tiers with descending levels of evidence combined with the utilization of single nucleotide polymorphism (SNP) causality prediction methods. The PGL score has the potential to explain the genetic background of complex bilirubin induced neurological disorders (BIND) such as kernicterus and could be the key to understanding ranges of outcome severity in complex diseases. We anticipate that this method could be useful for improving the care of jaundiced newborns through its use as an at-risk screen. Importantly, this method would also be useful in uncovering basic knowledge about this and other polygenetic diseases whose genetic source is difficult to discern through traditional means such as a genome-wide association study.
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Affiliation(s)
- Sean M Riordan
- Division of Child Neurology, Department of Pediatrics, Children's Mercy HospitalKansas City, MO, USA; Department of Neurology, University of Kansas Medical CenterKansas City, KS, USA
| | - Douglas C Bittel
- Ward Family Heart Center, Children's Mercy HospitalKansas City, MO, USA; Department of Pediatrics, University of Missouri-Kansas City School of MedicineKansas City, MO, USA
| | - Jean-Baptiste Le Pichon
- Division of Child Neurology, Department of Pediatrics, Children's Mercy HospitalKansas City, MO, USA; Department of Neurology, University of Kansas Medical CenterKansas City, KS, USA; Department of Pediatrics, University of Missouri-Kansas City School of MedicineKansas City, MO, USA; Department of Pediatrics, University of Kansas Medical CenterKansas City, KS, USA
| | - Silvia Gazzin
- Italian Liver Foundation, Centro Studi Fegato (CSF) Trieste, Italy
| | - Claudio Tiribelli
- Italian Liver Foundation, Centro Studi Fegato (CSF)Trieste, Italy; Department of Medical Sciences, University of TriesteTrieste, Italy
| | - Jon F Watchko
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine Pittsburgh, PA, USA
| | | | - Steven M Shapiro
- Division of Child Neurology, Department of Pediatrics, Children's Mercy HospitalKansas City, MO, USA; Department of Neurology, University of Kansas Medical CenterKansas City, KS, USA; Department of Pediatrics, University of Missouri-Kansas City School of MedicineKansas City, MO, USA; Department of Pediatrics, University of Kansas Medical CenterKansas City, KS, USA
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23
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Sriraman NK, Kellams A. Breastfeeding: What are the Barriers? Why Women Struggle to Achieve Their Goals. J Womens Health (Larchmt) 2016; 25:714-22. [PMID: 27111125 DOI: 10.1089/jwh.2014.5059] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite recognized health benefits for both mothers and infants, significant disparities still exist in the rates of breastfeeding in the United States. Major organizations representing the health of women and children (including the Centers for Disease Control and Prevention [CDC], American Academy of Pediatrics [AAP], American Congress of Obstetrics and Gynecology [ACOG], American Academy of Family Physicians [AAFP], United Nations International Children's Emergency Fund (UNICEF), the World Health Organization [WHO], and the United States Public Health Service [PHS]) recommend exclusive breastfeeding, but statistics show that although many women initiate breastfeeding, few meet the recommended goals for duration and exclusivity. This article reviews the evidence related to barriers (prenatal, medical, societal, hospital, and sociocultural) that many mothers face, and explore the known barriers and the impact they have on a woman's ability to breastfeed her infant. Strategies will be discussed to address (and potentially overcome) some of the most common barriers women face along with a list of resources that can be useful in this effort. Gaps in care and areas that need further research will be noted. This article is targeted toward physicians and other healthcare providers who work with women and who can assist with and advocate for the removal of barriers and thereby improve the health of women and children by increasing the rates of breastfeeding initiation, duration, and exclusivity in the United States.
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Affiliation(s)
- Natasha K Sriraman
- Division of General Academic Pediatrics, Children's Hospital of the King's Daughters/Eastern Virginia Medical School , Norfolk, Virginia.,Well Newborn and Breastfeeding Medicine Services, Department of Pediatrics, University of Virginia , Charlottesville, Virginia
| | - Ann Kellams
- Division of General Academic Pediatrics, Children's Hospital of the King's Daughters/Eastern Virginia Medical School , Norfolk, Virginia.,Well Newborn and Breastfeeding Medicine Services, Department of Pediatrics, University of Virginia , Charlottesville, Virginia
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Boubred F, Herlenius E, Andres V, des Robert C, Marchini G. Morbidité néonatale précoce après sortie de maternité : étude comparative entre deux maternités à Stockholm et Marseille. Arch Pediatr 2016; 23:234-40. [DOI: 10.1016/j.arcped.2015.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 07/03/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
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Perme T, Škafar Cerkvenik A, Grosek Š. Newborn Readmissions to Slovenian Children's Hospitals in One Summer Month and One Autumn Month: A Retrospective Study. Pediatr Neonatol 2016; 57:47-52. [PMID: 26134544 DOI: 10.1016/j.pedneo.2015.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/17/2014] [Accepted: 04/01/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND With the shortening length of stay of newborns in hospitals after birth, concerns have been raised about the possible rise in readmission rates. In Slovenia, where the normal length of stay is 3 days, no data on readmissions were available. We sought to determine the frequency and causes for readmissions. METHODS We conducted a retrospective study on all newborns readmitted to Slovenian children's hospitals and wards in June 2012 and November 2012. We obtained basic demographic data for newborns and mothers, analyzed the frequency of diagnoses, and compared the duration of treatment between summer months and autumn months. RESULTS The proportion of readmissions in June 2012 and November 2012 was 6% and 5.9%, respectively. Around 10% more boys were readmitted in June 2012 and November 2012. In June 2012, the mean age was 12.2 days, and the mean birth weight was 3444 g. In November, the mean age was 10.5 days, and the mean birth weight was 3271 g. Around 50% of mothers were primiparous, and their mean age was around 31 years. Most received > 10 prenatal check-ups and participated in a prenatal class. The most common diagnosis in June 2012 and November 2012 was jaundice. The duration of treatment did not statistically significantly differ between summer months and autumn months, but it was associated with the admission diagnosis and infants' characteristics. CONCLUSION Our study showed that the readmission rate in Slovenia was much higher than in some other developed countries. Prospective studies are needed to further confirm the findings and highlight the possible causes for this observation.
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Affiliation(s)
- Tina Perme
- MRC Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Community Health Centre Ljubljana, Ljubljana, Slovenia
| | | | - Štefan Grosek
- Department of Pediatric Surgery and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
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Damaged goods?: an empirical cohort study of blood specimens collected 12 to 23 hours after birth in newborn screening in California. Genet Med 2015; 18:259-64. [DOI: 10.1038/gim.2015.154] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/14/2015] [Indexed: 11/08/2022] Open
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Bayoumi YA, Bassiouny YA, Hassan AA, Gouda HM, Zaki SS, Abdelrazek AA. Is there a difference in the maternal and neonatal outcomes between patients discharged after 24 h versus 72 h following cesarean section? A prospective randomized observational study on 2998 patients. J Matern Fetal Neonatal Med 2015; 29:1339-43. [PMID: 26037723 DOI: 10.3109/14767058.2015.1048678] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the incidence of postpartum maternal and neonatal complications and hospital readmission in patients discharged 24 versus 72 h after cesarean section. METHODS Using randomization, 1495 patients were discharged after 24 h and 1503 patients were discharged after 72 h. All patients fulfilled the discharge criteria. Patients were assessed 6 weeks after delivery, any maternal or neonatal problems or hospital readmissions during this time interval were reported. RESULTS There was no difference in maternal hospital readmission between the two groups, but there was a significantly higher neonatal readmission rate in the 24-h group mainly due to neonatal jaundice. As for the complications reported after 6 weeks, the only two significant outcomes were initiating breast feeding, being significantly higher in the 72-h group [OR and 95% CI 0.77 (0.66-0.89)] and the mood swings being significantly lower in the 72-h group [OR and 95% CI 2.28 (1.94-2.68)]. CONCLUSION Our recommendation is still in favor of late discharge, after cesarean delivery. Bearing in mind, that an early 24-h discharge, after cesarean delivery is feasible, but with special care of the neonate, with early visit to the pediatrician and early establishment of effective lactation.
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Seagraves K, Brulte A, McNeely K, Pritham U. Supporting breastfeeding to reduce newborn readmissions for hyperbilirubinemia. Nurs Womens Health 2015; 17:498-507. [PMID: 24589050 DOI: 10.1111/1751-486x.12078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Lack of breastfeeding support can result in inadequate feedings at the breast, putting newborns at risk for hyperbilirubinemia, severe jaundice and possible hospital readmission. Nurses can help prevent readmissions for hyperbilirubinemia by becoming educated about the risk factors for hyperbilirubinemia and by implementing preventive measures through improved breastfeeding support.
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De Carolis MP, Cocca C, Valente E, Lacerenza S, Rubortone SA, Zuppa AA, Romagnoli C. Individualized follow up programme and early discharge in term neonates. Ital J Pediatr 2014; 40:70. [PMID: 25024007 PMCID: PMC4223512 DOI: 10.1186/1824-7288-40-70] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/30/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Early discharge of mother/neonate dyad has become a common practice, and its effects are measured by readmission rates. We evaluated the safety of early discharge followed by an individualized Follow-up programme and the efficacy in promoting breastfeeding initiation and duration. METHODS During a nine-month period early discharge followed by an early targeted Follow-up was carried out in term neonates in the absence of weight loss <10% or hyperbilirubinaemia at risk of treatment. Follow-up visits were performed at different timepoints with a specific flow-chart according to both bilirubin levels and weight loss at discharge. RESULTS During the study period early discharge was performed in 419 neonates and Follow-up was carried out in 408 neonates (97.4%). No neonates required readmission for hyperbilirubinaemia and dehydration during the first 28 days of life. Breastfeeding rate was 90.6%, 75.2%, 41.5% at 30, 90 and 180 days of life, respectively. A six-month phone interview was performed for 383 neonates (93.8%) and satisfaction of parents about early discharge was high in 345 cases (90.1%). CONCLUSIONS Early discharge in association with an individualized Follow-up programme resulted safe for the neonate and effective for breastfeeding initation and duration.
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Affiliation(s)
- Maria Pia De Carolis
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Carmen Cocca
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Elisabetta Valente
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Serafina Lacerenza
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Serena Antonia Rubortone
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Antonio Alberto Zuppa
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Costantino Romagnoli
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
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