Adherence to AAP Healthy Newborn Discharge Criteria in a Tertiary Care Children’s Hospital

Abstract

A B S T R A C TOBJECTIVES: 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 5 433) 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.

Discharge preparation and readiness after birth: a scoping review of global policies, guidelines and literature

“…Thirteen policy documents reported discharge readiness criteria [ 24 , 33 , 34 , 37 – 46 ]. Seventeen research documents reported readiness criteria, and these included nine research studies [ 11 , 12 , 25 , 31 , 32 , 35 , 47 – 49 ], three review articles [ 36 , 50 , 51 ], two commentaries [ 52 , 53 ], a thesis [ 54 ], a medical news article [ 55 ] and an unpublished evaluation report [ 56 ]. Policy documents were from the United States ( n = 3), Canada ( n = 2), India ( n = 2), England ( n = 1) and five of the policy documents had a global focus.…”

“…physical exam, danger signs, pain/discomfort) 10 [59%] [ 11 , 12 , 31 , 32 , 47 , 49 , 50 , 53 , 55 , 56 ] 7 [54%] [ 37 , 39 , 41 – 43 , 45 , 46 ] Infant health (e.g. physical exam, danger signs, breastfeeding, vnutrition/weight status) 10 [59%] [ 32 , 35 , 36 , 47 , 50 – 53 , 55 , 56 ] 10 [77%] [ 24 , 33 , 34 , 37 , 41 – 43 , 45 , 46 ] Low birth weight (e.g. stable breathing, full feeds, sustained weight gain) 1 [6%] [ 25 ] 1 [8%] [ 24 ] Tests (e.g.…”

“…maternal serologies, infant metabolic screening, infant hearing screening, infant APGAR test) 8 [47%] [ 36 , 47 , 50 – 53 , 55 , 56 ] 7 [54%] [ 24 , 33 , 34 , 37 , 38 , 42 , 44 ] Treatment (e.g. newborn immunisations, infant HepB vaccine, ARVs for mother and baby if HIV+) 6 [35%] [ 32 , 35 , 36 , 51 , 52 , 56 ] 8 [62%] [ 24 , 33 , 34 , 37 , 38 , 42 – 44 ] Knowledge, ability and confidence regarding self-care and infant care 13 [76%] [ 11 , 12 , 25 , 31 , 35 , 36 , 47 – 53 ] 11 [85%] [ 24 , 33 , 34 , 37 – 40 , 42 – 45 ] Education (information provided to mother on various topics e.g. breastfeeding, care of newborn, car seat safety, family planning, hygiene practices) 3 [18%] [ 36 , 47 , 52 ] 10 [77%] [ …”

“…newborn immunisations, infant HepB vaccine, ARVs for mother and baby if HIV+) 6 [35%] [ 32 , 35 , 36 , 51 , 52 , 56 ] 8 [62%] [ 24 , 33 , 34 , 37 , 38 , 42 – 44 ] Knowledge, ability and confidence regarding self-care and infant care 13 [76%] [ 11 , 12 , 25 , 31 , 35 , 36 , 47 – 53 ] 11 [85%] [ 24 , 33 , 34 , 37 – 40 , 42 – 45 ] Education (information provided to mother on various topics e.g. breastfeeding, care of newborn, car seat safety, family planning, hygiene practices) 3 [18%] [ 36 , 47 , 52 ] 10 [77%] [ 24 , 34 , 37 – 40 , 42 – 45 ] Low birth weight (e.g. training for parents on oxygen and/or tube feeds) 1 [6%] [ 25 ] 0 Assessment of maternal confidence and knowledge (e.g.…”

Newborn Clinic: A Novel Model to Provide Timely, Comprehensive Care to Newborns Following Nursery Discharge

“…Among the most commonly missed items were timely pediatrician follow-up appointment, social risk factor assessment, observation of breastfeeding, and car seat education. 15 The NBC model is uniquely suited to both provide timely outpatient follow-up and to address the most commonly missed items. Of particular note is NBC's commitment to assuring safe and supported breastfeeding-education of mother and family, observed feeding sessions, and ongoing lactation support are all discrete items on the discharge readiness checklist.…”