Early Readmission of Newborns in a Large Health Care System
ABSTRACT BACKGROUND:Early readmissions of apparently healthy newborns after discharge from well baby nurseries (WBN) may reflect an inadequate assessment of the newborn's readiness for discharge.OBJECTIVE:To determine the frequency, causes, costs, and variations in rates of early rehospitalization of newborns discharged from 21 WBNs in 1 health care system.METHODS:We queried the Enterprise Data Warehouse of Intermountain Healthcare (IH), a large Utah health care system, to identify newborns with gestational ages of 34 to 42 weeks discharged from an IH WBN between 2000 and 2010. We identified all newborns admitted to an IH hospital within 28 days of discharge and recorded their birth hospital, age, reason(s) for admission, length of stay, and inpatient costs.RESULTS:During the study period, 296 114 babies were discharged from IH hospital WBNs. Of these, 5308 (17.9/1000) were readmitted within 28 days of discharge. Of the 5308 babies who were readmitted, 41% had feeding problems, 35% had jaundice, and 33% had respiratory distress. The majority of newborns with feeding problems and jaundice were admitted in their first 2 weeks of life. Late preterm and early term newborns had higher rates of readmission than term infants. There were significant variations in readmission rates of newborns born at the 21 hospitals in the IH system.CONCLUSIONS:Potentially preventable conditions, including feeding problems and jaundice, account for most early readmissions of newborns. Late preterm and early term newborns have higher rates of readmission and should be assessed for other factors associated with early readmission.
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ABSTRACT: Oral feeding readiness is a complex concept. More evidence is needed on how to approach beginning oral feedings in premature hospitalized infants. This article provides a review of literature related to oral feeding readiness in the premature infant and strategies for promoting safe and efficient progression to full oral intake. Oral feeding readiness assessment tools, clinical pathways, and feeding advancement protocols have been developed to assist with oral feeding initiation and progression. Recognition and support of oral feeding readiness may decrease length of hospital stay and have a positive impact on reducing healthcare costs. Supporting effective cue-based oral feeding through use of rigorous assessment or evidence-based care guidelines can also optimize the hospital experience for infants and caregivers, which, in turn, can promote attachment and parent satisfaction.MCN The American Journal of Maternal/Child Nursing 12/2014; 40(2). DOI:10.1097/NMC.0000000000000115 · 0.84 Impact Factor
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ABSTRACT: Among infants born moderately and late preterm or early term, the greatest challenge for breastfeeding management is the late preterm infant (LPI) who is cared for with the mother in the maternity setting. Breastfeeding failure among LPIs and their mothers is high. Evidence-based strategies are needed to protect infant hydration and growth, and the maternal milk supply, until complete feeding at breast can be established. This article reviews the evidence for lactation and breastfeeding risks in LPIs and their mothers, and describes strategies for managing these immaturity-related feeding problems. Application to moderately and early preterm infants is made throughout.Clinics in perinatology 12/2013; 40(4):689-705. DOI:10.1016/j.clp.2013.07.014 · 2.13 Impact Factor
- 02/2014; 168(4). DOI:10.1001/jamapediatrics.2013.5238