Date of Award

2018

Degree Type

Dissertation

Degree Name

Doctor of Philosophy in Nursing

Department

Nursing

First Advisor

Debra A. Erickson-Owens

Abstract

Hospital readmissions are a patient safety and quality concern. Readmission rates in term-born infants in the past decade have been < 1.3% in the United States and < 8% globally. Most readmissions have been for jaundice/hyperbilirubinemia. Changes in exclusive breastfeeding rates, healthcare/institutional policies and demographics may have influenced the rate of neonatal readmission. Most literature on term-born neonatal readmission (within 28 days of birth) is conflicting and outdated. This study aimed to quantify the risk of maternal, infant, provider and institutional factors associated with neonatal readmission to the birth hospital in healthy term infants. Secondary aims estimated the incidence of neonatal readmission and characterized birth length of stay (in hours), readmission diagnosis, birth weight loss > 7% and breastfeeding quality ([LATCH score] ≤ 6). A nested case-control study (N=390) was conducted at a Level III hospital in the Northeastern United States. There were 11, 958 infants delivered between January 1, 2016 through May 8, 2017. A cohort of in-state domicile, healthy term (370/7 - 416/7 weeks gestation) infants (n = 5,940) admitted directly to the well-baby nursery were identified. Cases (n =130) were infants from the cohort readmitted within 28 days of birth to the birth hospital. Controls (n =260) were randomly selected for each case (2:1) from the same cohort (matched on maternal age and infant birth date [+/- 7 days]). Descriptive statistics and conditional logistic regression were performed. Meleis’s Transitions Theory guided variable selection. Significant factors associated with neonatal readmission were gestational age (370/6- 396/7 weeks) (p < 0.001), maternal treatment for group B streptococcus (OR 2.55, p = 0.012), and jaundice on day two of life (OR 2.45, p = 0.002). Infants delivered by cesarean (OR 0.31, p = 0.014) and infants who received formula (when indicated) in the first three days of life, were 0.04% less likely to be readmitted (OR 0.96, p = 0.005) for every 10 milliliters of formula consumed. The exclusive breastfeeding rate was 47.7%. Birth weight loss > 7% and LATCH score ≤ 6 were not associated with neonatal readmission. The incidence rate of neonatal readmission was 2.2%. Most readmissions (93%) were for jaundice/ hyperbilirubinemia and all infants were readmitted within 8.6 days of birth. The average birth length of stay (in hours) was 54.6 ± 16.8 [16.53-126.30]. Future research on maternal group B streptococcus treatment and the risk of neonatal readmission in healthy term-born infants is needed. The findings highlight the need for a state-wide database and reporting of all neonatal readmissions (not just to the birth hospital) to assess the true scope of the problem.

Available for download on Saturday, July 11, 2020

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