Frequency and Reasons for Newborn Readmission after Discharge from the Maternity Ward
Nikolina Cuvalo1, Marjana Jerković Raguz2*
1Faculty of Medicine, University of Mostar, Bosnia and Herzegovina
2Department of Neonatology and Intensive Care Unit, Clinic for Children's Diseases, University Clinical Hospital of Mostar, Bosnia and Herzegovina
*Corresponding author: Marjana Jerkovic Raguz, Clinic for Children's Diseases, University Clinical Hospital of Mostar, Bosnia and Herzegovina. Tel: +38763699089; Email: marjanajerkovic@yahoo.co.uk
Received
Date: 26 July,
2017; Accepted Date: 01 August, 2017;
Published Date: 08 August, 2017
Citation: Cuvalo N, Raguz MJ (2017) Frequency and Reasons for Newborn Readmission after Discharge from the Maternity Ward. Infect Dis Diag Treat: IDDT-112.
1. Abstract
1.1. Aim: The aim of this paper was to determine the frequency and the reasons for newborn readmissions at the Clinic for Pediatric Diseases at the University Clinical Hospital Mostar.
1.2. Methods: The retrospective study included 71 newborns readmitted at the Clinic of Pediatric diseases over the course of one year. The surveyed group consisted for children who met the criterion of hospital readmissionswhich included newborns who were released from the maternity ward, but returned to the hospital within the first 30 days of life, due to the development of some pathological condition.
1.3. Results: The readmission rate expressed as readmitted infants within 30 days compared to 1,000 live births was 38.89 ‰. By analyzing the working diagnoses of readmitted newborns, we found significantly more children with a diagnosis of newborn jaundice than other possible diagnoses (p <0.001). Statistically significant differences were found in the distribution of mothers according to all variables: number of births, delivery mode and complications during pregnancy (p <0.001).
1.4. Conclusion: The most common reasons for hospital readmission were newborn jaundice and respiratory infections. Rehospitalization has a significant impact on the family and it can be reduced by providing adequate health care and by treating the most common pathological conditions at the maternity ward.
2.
Keywords: Hospital Readmission;
Newborn; Respiratory Infections
1. Introduction
Neonatal morbidity was defined as any
medical condition resulting in post delivery inpatient hospital readmission,
observational stay, or mortality in the first 28 days of life [1]. A
readmission was defined as the admission of a newborn to any hospital after
discharge from the maternity ward. A newborn infant transferred directly from
another institution was not counted as a readmission [2]. While more refined measures of health outcomes
are desirable, newborn readmission is used because it reflects morbidity and it
is costly. In addition, newborn readmission is correlated with health problems
that critics of early discharge believe may be caused by short postpartum stays
[3]. High
readmission rates are viewed as a negative indicator of the quality of care during
hospitalization and, particularly, of the discharge assessment and process [4].
A newborn who is ill is
more likely to be readmitted than a newborn who is healthy and of importance is
the fact that some pathological conditions are more frequent than others
[3]. The
most frequently reported causes of infant readmission are: dehydration,
diarrhea, feeding problems, fever, infections, gastrointestinal problems,
jaundice, sepsis and viral/respiratory issues [5]. Recently,
rehospitalization of healthy term newborns has received scientific and media
attention [6]. Neonatal readmissions have a significant impact on new families
and may be decreased by appropriate hospital care and follow-up [7]. According
to generally accepted standards of maternity care, the health care needs of the
newborn and mother in the immediate postnatal/postpartum period should be met
at the delivery site. These needs include monitoring and support to ensure the
infant’s stabilization during the initial physiologic transition from intrauterine
to extra uterine environments, performance of recommended immunizations,
mandatory screening for genetic disorders, and initiation of feeding and
assessment of major medical risk factors [8]. Detection of significant
jaundice, ductal-dependant cardiac lesions, gastrointestinal obstruction, and
other problems may require a longer period of observation by skilled and
experienced health care professionals [9]. Longer length of stay before
discharge is protective against readmission but it is not reasonable to prolong
the hospitalization of newborns after birth who meet criteria for discharge
[10]. Preventable hospital readmissions are a topic of national focus as
potential indicators of clinical failure and unnecessary expenditures [11].
2. Aim
The aim of this paper was to determine the frequency and the
reasons for newborn’s readmission at the Clinic for Pediatric Diseases at the
University Clinical Hospital Mostar.
3. Subjects and
Methods
This retrospective study included 71 newborns readmitted at the
Clinic of Pediatric diseases at the University Clinical Hospital Mostar in the
period from January 2016 to January 2017. The surveyed group consisted of
children who met the criterion of hospital readmissions after being released
from the maternity ward, up to 30 days of age, due to the development of some
pathological condition. The study excluded all newborns that were immediately
transferred to the Department of Neonatology and Intensive care of newborns
from the maternity clinics. The following variables were observed in newborns:
age, gestational age, sex, gender, feeding mode, vaccine status, diagnosis,
department, duration and type of treatment. The variables observed in pregnant
women were: number of pregnancies and childbirths, birth mode and complications
during pregnancy. The data was collected using medical documentation from the
basis of the Clinic for Pediatric diseases. Data were analyzed in SPSS for
Windows (version 17.0., SPSS Inc. Chicago, Illinois, USA) and Microsoft Excel
(version Office 2007, Microsoft Corporation, Redmond, WA, USA). Results were
expressed as number and relative frequencies (%). The Chi-square (χ2)
test was used for testing the statistical significance. The level of
significance was p=0.05. P values that could not be expressed to three decimal
places are shown as p<0.001.
4. Results
The number of live-born children at the Department of Gynecology
at the University Clinical Hospital Mostar during 2016 was 1821 children. The
readmission rate expressed as readmitted infants within 30 days compared to
1,000 live births was 38.89 %.
By analyzing the working diagnoses of readmitted newborns, we
found significantly more children with a diagnosis of newborn jaundice than
other possible diagnoses (χ2=72.746; df=13; p<0.001).
Statistically significant differences were found in the
distribution of newborns according to gestational age, gender, birth weight,
feeding mode and vaccine status.
Statistically significant differences were
found in the distribution of mothers according to all variables: number of
births, delivery mode and complications during pregnancy.
The research has shown a statistically
significant difference in the presence of individual release diagnoses (χ2=23.310;
df=7; p=0.002). The most common cause
for rehospitalization was newborn jaundice.
5. Discussion
This study determined that the frequency
for newborn’s readmission at the Clinic for Pediatric Diseases at the
University Clinical Hospital Mostar in 2016 was 38.98 ‰, while the most
common reasons for hospital readmission were newborn jaundice and respiratory
infections. The research from Canada showed that the incidence of newborn’s readmission has increased
over the past few decades, while the average length of stay decreased from 4 to
2 days [2]. According to our study, children born vaginally had a greater
incidence of readmission than children born by C-section, which could mean that
longer length of stay in the maternity ward for infants born by C-section
reduces the risk of rehospitalization. These conclusions are confirmed by the
American study [12]. According to another study, the first week of life is the
most critical period for newborns [8], while our research found a higher number
of readmissions in the 4th week of life. By analyzing working diagnoses, we
found that the leading causes of the hospital readmissions were increased
bilirubin count and fever, while the study done in the US in 2013 showed that
infections were the most common cause of hospitalization [13]. A study from
Austria showed that male newborns were hospitalized more often than females,
especially for respiratory diseases [14], and, while this was a statistically
significant finding, such a result was not found in our research. Some studies
indicate that lower gestational age and lower birth weight do not have an impact on newborn read mission
rates [15]. Newborn jaundice and respiratory infections, according to our
research, occured most frequently in newborns between 38 and 40 weeks
gestation, while gender had no major influence on the occurrence of certain
diagnoses. These results match with the analysis from 2013 [4]. We also found
that uncomplicated and multiparity pregnancies and vaginal delivery were the
most common [16]. It is explained by the fact that babies born vaginally are
discharged prior to infants born by C-section, so certain pathological
conditions develop as the infant enters the home environment [5].
Therefore, an increase in a newborn’s readmission rate means an
increase in healthcare costs and therefore, certain measures should be taken to
prevent hospitalization and reduce the overall rates. We believe that
increasing the length of stay and improving health care is not a major
investment, and can bring a great benefit not only to the system, children and
families, but to the entire society as well.
6. Conclusion
This study determined that the frequency
for newborn readmission at the Clinic for Pediatric Disease in 2016 was 38.98
‰, while the most common reasons for hospital readmission were newborn jaundice
and respiratory infections. Rehospitalization has a significant impact on the
family and it can be reduced by providing adequate health care and by treating
the most common pathological conditions at the maternity ward.
7. Conflict of Interest
The manuscript has not been published or
submitted for publishing elsewhere, the manuscript has been read and approved
by all the authors, and there is no any financial or other conflict of
interest.
Graph 1: Working diagnoses
during hospital readmission.
Graph
2: Release
diagnoses during hospital readmission.
Variables |
|
Number of newborns |
% |
χ2 test |
p |
Gestational age |
<38 |
5 |
7 |
79.211 |
<0.001 |
38-40 |
59 |
83.1 |
|||
>40 |
7 |
9.9 |
|||
Gender |
m |
34 |
47.9 |
0.127 |
0.722 |
ž |
37 |
52.1 |
|||
Birth weight (g) |
2 000-2 499 |
3 |
4.2 |
32.592 |
<0.001 |
2 500-2 999 |
10 |
14.1 |
|||
3 000-3 499 |
28 |
39.4 |
|||
3 500-3 999 |
23 |
32.4 |
|||
4 000-4 499 |
7 |
9.9 |
|||
Feeding mode |
breastfeeding |
54 |
76.1 |
19.282 |
<0.001 |
breastfeeding and milk formula |
17 |
23.9 |
|||
Vaccine status |
no |
9 |
12.7 |
35.268 |
<0.001 |
yes |
47 |
66.2 |
|||
unknown data |
15 |
21.2 |
Table 1: Distribution of newborns according to gestational age, gender, birth weight, feeding mode and vaccination status.
|
Number of mothers |
% |
χ2 test |
p |
|
Number of births |
1 |
27 |
38 |
4.07 |
0.044 |
2+ |
44 |
62 |
|||
Delivery mode |
vaginal |
60 |
85 |
33.817 |
<0.001 |
C-section |
11 |
16 |
|||
Complications during pregnancy |
no |
46 |
65 |
6.211 |
0.013 |
yes |
25 |
35 |
Table 2: Distribution of mothers according to the number of births, delivery mode and the occurrence of complications during pregnancy.
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