Neonatal readmissions are a global concern with rates as high as 10.1% outside the US (Bayoumi, et al., 2015). Neonatal readmission rates in the US have been less than 1% (Geiger, Pettiti, & Yao, 2001; Radmacher, Massey, & Adamkin, 2002). However, according to data from the National Perinatal Information Center (NPIC), the rate for all inborn neonatal readmissions for 2016 (among the 93 member hospitals included in the analysis) is approximately 1.0 to 2.6% (NPIC: Quality Analytics Services, 2017).
The goal is to increase breastfeeding rates worldwide (World Health Organization, UNICEF, 2017). Rates of breastfeeding have also been rising in the US following the Healthy People 2020 health initiative (Baby-Friendly USA, Inc, 2012). It is not known if increases in the rate of breastfeeding and breastfeeding difficulty, have contributed to increased rates of neonatal readmission. Breastfeeding problems need to be anticipated and assessed prior to discharge from the hospital (Evans, Marinelli, Taylor, & Academy of Breastfeeding Medicine, 2014). More than 7 % birth weight loss may be significant and may require intervention. (Thulier, 2016). Studies in the US in the past decade on neonatal readmission in term infants are from 2001 and 2002.
Inadequate assessment by healthcare providers and diagnostic errors may place the infant at increased risk for hospital readmission (American Academy of Pediatrics: Committee on Fetus and the Newborn, 2015). The readmission of an infant discharged home as a healthy infant following the birth hospitalization is an emotional, social, and financial burden on the family and the hospital system (Habib, 2013). According to the AAP guidelines, readiness for discharge is determined by the pediatrician with input from other health care providers and the mother. This is following an evaluation of maternal, infant and social factors such as the ability of the parents/family to care for the infant at home (AAP: Committee on Fetus and the Newborn, 2015).
There is a lack of evidence on current pre-discharge factors associated with neonatal readmission in term infants discharged home as healthy newborns. Pre-discharge policies have not been defined or described in the literature, and it is assumed that institutional policies are followed. The true scope of the number of avoidable neonatal readmissions and the factors associated with them in term infants discharged home as healthy newborns is not known.
Purpose: 1) determine the incidence, birth length of stay (in hours), and diagnosis (ICD-10 codes) for healthy term infant readmissions (within 28 days of birth) to the birth hospital; and to 2) identify the maternal, infant, provider and institutional factors related to neonatal readmissions in healthy term infants (370/7 to 416/7 weeks gestational age).
Methods: Nested case control design (ongoing). The cohort included all term infants of mothers who resided and delivered at a large birthing center in one of the North-East states in the United States. One hundred and thirty infants who were readmitted to the birthing hospital within 28 days of birth beginning in January 2016 through December 31, 2016 were included as cases. Controls were selected from the same cohort using incidence density sampling with a replacement in a ratio of 2:1. Control infants were within +/- 1 week of the case (index) infant’s date of birth and the mother’s maternal age categorized as (<20; 20-29; 30-39; and >39 years old). Descriptive analyses and conditional heirarchical logistic regression were performed.
Results: (will be added here)
Conclusion: (will be based on findings)
Nurses are in a unique position to evaluate mother-infant dyads prior to discharge home, and to develop nursing sensitive indicators for structure, process and outcomes related to reducing preventable neonatal readmissions. The findings of this study may add to the understanding of improving nursing care delivery, patient outcomes and patient satisfaction, as well as reduce the costs of avoidable readmission to the health care system.