Abstract
Objective
Ongoing health care challenges, low breast milk intake, and the need for rehospitalization are common during the first year of life after hospital discharge for very low birth weight (VLBW) infants. This retrospective cohort study examined breast milk intake, growth, emergency department (ED) visits, and non-surgical rehospitalizations for VLBW infants who received specialized post-discharge follow-up in western Canada, compared to VLBW infants who received standard follow-up in central Canada.
Design
Data were collected from two neonatal follow-up programs for VLBW babies (n = 150 specialized-care; n = 205 standard-care). Logistic regression was used to examine odds of breast milk intake and generalized estimating equations were used for odds of growth, ED visits and non-surgical rehospitalization by site.
Results
Specialized-care was associated with enhanced breast milk intake duration; the odds of receiving breastmilk at 4 months in the specialized-care cohort was 6 times that in the standard-care cohort. The specialized-care cohort had significantly more ED visits and rehospitalizations. However, for infants with oxygen use beyond 36 weeks compared to those with no oxygen use, the standard-care cohort had over 7 times the odds of rehospitalization where as the specialized-care cohort with no increased odds of rehospitalization.
Conclusion
Specialized neonatal nursing follow-up was associated with continued breastmilk intake beyond discharge. Infants in the specialized-care cohort used the ED and were hospitalized more often than the standard-care cohort with the exception of infants with long term oxygen needs.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- ED:
-
emergency department
- NICU:
-
neonatal intensive care unit
- VLBW:
-
very low birth weight
References
Aloysius, A., Kharusi, M., Winter, R., Platonos, K., Banerjee, J., & Deierl, A. (2018). Support for families beyond discharge from the NICU. Journal of Neonatal Nursing. https://doi.org/10.1016/j.jnn.2017.11.013
Bapat, R., McClead, R., Shepherd, E., Ryshen, G., & Bartman, T. (2016). Challenges, successes and opportunities for reducing readmissions in a referral-based children’s hospital NICU. Journal of Neonatal-Perinatal Medicine. https://doi.org/10.3233/NPM-161624
Belfort, M. B., Anderson, P. J., Nowak, V. A., Lee, K. J., Molesworth, C., Thompson, D. K., Doyle, L. W., & Inder, T. E. (2016). Breast milk feeding, brain development, and neurocognitive outcomes: A 7-year longitudinal study in infants born at less than 30 weeks’ gestation. Journal of Pediatrics. https://doi.org/10.1016/j.jpeds.2016.06.045
Briere, C. E., Mcgrath, J., Cong, X., & Cusson, R. (2014). An integrative review of factors that influence breastfeeding duration for premature infants after NICU hospitalization. In JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing. https://doi.org/10.1111/1552-6909.12297
Brooten, D., Kumar, S., Brown, L. P., Butts, P., Finkler, S. A., Bakewell-Sachs, S., Gibbons, A., & Delivoria-Papadopoulos, M. (1986). A randomized clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants. New England Journal of Medicine. https://doi.org/10.1056/NEJM198610093151505
Daglas, M., Sidiropoulou, C., Galanis, P., Bilali, A., Antoniou, E., & Iatrakis, G. (2020). Maternal and neonatal factors associated with successful breastfeeding in preterm infants. International Journal of Caring Sciences, 13(1), 152–162. https://www.researchgate.net/publication/341712794
Davanzo, R., Monasta, L., Ronfani, L., Brovedani, P., & Demarini, S. (2013). Breastfeeding at NICU discharge: A multicenter italian study. Journal of Human Lactation. https://doi.org/10.1177/0890334412451055
Dodge, K. A., Goodman, W. B., Murphy, R. A., O’donnell, K., & Sato, J. (2013). Randomized controlled trial of universal postnatal nurse home visiting: Impact on emergency care. Pediatrics. https://doi.org/10.1542/peds.2013-1021M
Ericson, J., Flacking, R., & Udo, C. (2017). Mothers’ experiences of a telephone based breastfeeding support intervention after discharge from neonatal intensive care units: A mixed-method study. International Breastfeeding Journal. https://doi.org/10.1186/s13006-017-0142-9
Fenton, T. R., & Kim, J. H. (2013). A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatrics. https://doi.org/10.1186/1471-2431-13-59
Glass, H. C., Costarino, A. T., Stayer, S. A., Brett, C. M., Cladis, F., & Davis, P. J. (2015). Outcomes for extremely premature infants. Anesthesia and Analgesia. https://doi.org/10.1213/ANE.0000000000000705
Goyal, N. K., Teeters, A., & Ammerman, R. T. (2013). Home visiting and outcomes of preterm infants: A systematic review. In Pediatrics. https://doi.org/10.1542/peds.2013-0077
Gregory, K. E., Samuel, B. S., Houghteling, P., Shan, G., Ausubel, F. M., Sadreyev, R. I., & Walker, W. A. (2016). Influence of maternal breast milk ingestion on acquisition of the intestinal microbiome in preterm infants. Microbiome. https://doi.org/10.1186/s40168-016-0214-x
Hong, T., Bolisetty, S., Bajuk, B., Abdel-Latif, M., Oei, J., Jaffe, A., & Lui, K. (2016). A population study of respiratory rehospitalisation in very preterm infants in the first 3 years of life. Journal of Paediatrics and Child Health. https://doi.org/10.1111/jpc.13205
Hüning, B. M., Reimann, M., Beerenberg, U., Stein, A., Schmidt, A., & Felderhoff-Müser, U. (2012). Establishment of a family-centred care programme with follow-up home visits: Implications for clinical care and economic characteristics. Klinische Padiatrie. https://doi.org/10.1055/s-0032-1327620
Ikonen, R., Paavilainen, E., & Kaunonen, M. (2015). Preterm infants’ mothers’ experiences with milk expression and breastfeeding: An integrative review. Advances in Neonatal Care. https://doi.org/10.1097/ANC.0000000000000232
Johnston, K. M., Gooch, K., Korol, E., Vo, P., Eyawo, O., Bradt, P., & Levy, A. (2014). The economic burden of prematurity in Canada. BMC Pediatrics. https://doi.org/10.1186/1471-2431-14-93
Kalkman, S., Van Thiel, G., Van Der Graaf, R., Zuidgeest, M., Goetz, I., Grobbee, D., & Van Delden, J. (2017). The social value of pragmatic trials. Bioethics (31 vol., pp. 136–143). Wiley Subscription Services, Inc. 2https://doi.org/10.1111/bioe.12315
Kim, J. S., Shim, J. W., Lee, J. H., & Chang, Y. S. (2017). Comparison of follow-up courses after discharge from neonatal intensive care unit between very low birth weight infants with and without home oxygen. Journal of Korean Medical Science. https://doi.org/10.3346/jkms.2017.32.8.1295
Korvenranta, E., Lehtonen, L., Peltola, M., Häkkinen, U., Andersson, S., Gissler, M., Hallman, M., Leipälä, J., Rautava, L., Tammela, O., & Linna, M. (2009). Morbidities and hospital resource use during the first 3 years of life among very preterm infants. Pediatrics. https://doi.org/10.1542/peds.2008-1378
Kuo, D. Z., Lyle, R. E., Casey, P. H., & Stille, C. J. (2017). Care system redesign for preterm children after discharge from the NICU. Pediatrics. https://doi.org/10.1542/peds.2016-2969
Lagatta, J., Murthy, K., Zaniletti, I., Bourque, S., Engle, W., Rose, R., Ambalavanan, N., & Brousseau, D. (2020). Home oxygen use and 1-year readmission among infants born preterm with bronchopulmonary dysplasia discharged from children’s hospital Neonatal Intensive Care Units. Journal of Pediatrics. https://doi.org/10.1016/j.jpeds.2020.01.018
Lapcharoensap, W., Bennett, M. V., Xu, X., Lee, H. C., & Dukhovny, D. (2020). Hospitalization costs associated with bronchopulmonary dysplasia in the first year of life. Journal of Perinatology. https://doi.org/10.1038/s41372-019-0548-x
Larsson, C., Wågström, U., Normann, E., & Thernström Blomqvist, Y. (2017). Parents experiences of discharge readiness from a Swedish neonatal intensive care unit. Nursing Open. https://doi.org/10.1002/nop2.71
Lasby, K., Newton, S., & von Platen, A. (2004). Neonatal transitional care. In The Canadian nurse (Vol. 100, Issue 8, pp. 18–23). https://doi.org/10.7748/ns.3.44.46.s63
Liu, Y., McGowan, E., Tucker, R., Glasgow, L. S., Kluckman, M., & Vohr, B. (2018). Transition home plus program reduces medicaid spending and health care use for high-risk infants admitted to the Neonatal Intensive Care Unit for 5 or more days. Journal of Pediatrics, 200. https://doi.org/10.1016/j.jpeds.2018.04.038
Lundberg, B., Lindgren, C., Palme-Kilander, C., Örtenstrand, A., Bonamy, A. K. E., & Sarman, I. (2016). Hospital-assisted home care after early discharge from a Swedish neonatal intensive care unit was safe and readmissions were rare. Acta Paediatrica International Journal of Paediatrics. https://doi.org/10.1111/apa.13393
Luu, T. M., Lefebvre, F., Riley, P., & Infante-Rivard, C. (2010). Continuing utilisation of specialised health services in extremely preterm infants. Archives of Disease in Childhood: Fetal and Neonatal Edition. https://doi.org/10.1136/adc.2009.173138
Méio, M. D. B. B., Villela, L. D., Gomes Júnior, S. C. dos, Tovar, S., C. M., & Moreira, M. E. L. (2018). Breastfeeding of preterm newborn infants following hospital discharge: Follow-up during the first year of life. Ciencia e Saude Coletiva. https://doi.org/10.1590/1413-81232018237.15742016
Niela-Vilén, H., Axelin, A., Melender, H. L., & Salanterä, S. (2015). Aiming to be a breastfeeding mother in a neonatal intensive care unit and at home: A thematic analysis of peer-support group discussion in social media. Maternal and Child Nutrition. https://doi.org/10.1111/mcn.12108
Patra, K., & Greene, M. M. (2018). Health care utilization after NICU discharge and neurodevelopmental outcome in the first 2 years of life in preterm infants. American Journal of Perinatology. https://doi.org/10.1055/s-0037-1608678
Taylor, J., Go, M., Nyp, M., Legino, J., Norberg, M., Dai, H., & Truong, W. (2016). Rehospitalization in infants born < 29 weeks’ gestation during the first 2 years of life: Risk assessment. American Journal of Perinatology, 33, 24–33
Treyvaud, K., Doyle, L. W., Lee, K. J., Roberts, G., Cheong, J. L. Y., Inder, T. E., & Anderson, P. J. (2011). Family functioning, burden and parenting stress 2 years after very preterm birth. Early Human Development. https://doi.org/10.1016/j.earlhumdev.2011.03.008
Vohr, B., McGowan, E., Keszler, L., O’Donnell, M., Hawes, K., & Tucker, R. (2018). Effects of a transition home program on preterm infant emergency room visits within 90 days of discharge. Journal of Perinatology. https://doi.org/10.1038/jp.2017.136
Vohr, B. R., Yatchmink, Y. E., Burke, R. T., Stephens, B. E., Cavanaugh, E. C., Alksninis, B., Nye, J. H., Bacani, D., McCourt, M. F., Collins, A. M., & Tucker, R. (2012). Factors associated with rehospitalizations of very low birthweight infants: Impact of a transition home support and education program. Early Human Development. https://doi.org/10.1016/j.earlhumdev.2011.10.011
Vohr, B., McGowan, E., Keszler, L., Alksninis, B., O’Donnell, M., Hawes, K., & Tucker, R. (2017). Impact of a transition home program on rehospitalization rates of preterm infants. Journal of Pediatrics. https://doi.org/10.1016/j.jpeds.2016.10.025
Vonderheid, S. C., Rankin, K., Norr, K., Vasa, R., Hill, S., & White-Traut, R. (2016). Health care use outcomes of an integrated hospital-to-home mother–preterm infant intervention. JOGNN - Journal of Obstetric Gynecologic and Neonatal Nursing. https://doi.org/10.1016/j.jogn.2016.05.007
Wilson, E., Christensson, K., Brandt, L., Altman, M., & Bonamy, A. K. (2015). Early provision of mother’s own milk and other predictors of successful breast milk feeding after very preterm birth: A regional observational study. Journal of Human Lactation. https://doi.org/10.1177/0890334415581164
Winter, L., Colditz, P. B., Sanders, M. R., Boyd, R. N., Pritchard, M., Gray, P. H., Whittingham, K., Forrest, K., Leeks, R., Webb, L., Marquart, L., Taylor, K., & Macey, J. (2018). Depression, posttraumatic stress and relationship distress in parents of very preterm infants. Archives of Women’s Mental Health. https://doi.org/10.1007/s00737-018-0821-6
Winter, L., Colditz, P. B., Sanders, M. R., Boyd, R. N., Pritchard, M., Gray, P. H., Whittingham, K., Forrest, K., Leeks, R., Webb, L., Marquart, L., Taylor, K., & Macey, J. (2018). Depression, posttraumatic stress and relationship distress in parents of very preterm infants. Archives of Women’s Mental Health. https://doi.org/10.1007/s00737-018-0821-6
Author information
Authors and Affiliations
Contributions
K Lasby and T Sherrow collected data, drafted the initial manuscript, and reviewed and revised the manuscript.
J Jackson and Dr. Kelly contributed to study design and data collection.
T Fenton, V Stagg and D McNeil analyzed data and guided research processes.
All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Corresponding authors
Ethics declarations
Financial Disclosure Statement
The authors have no financial relationships relevant to this article to disclose. No funding was required for this study.
Conflict of Interest Statement
The authors have no conflicts of interest relevant to this article to disclose.
Ethics Committee Review
Ethics approval was obtained from the Conjoint Health Research Ethics Board E-25,101 & Human Research Ethics Board, Mount Royal University #2013-20a.
Patients or the public WERE NOT involved in the design, or conduct, or reporting, or dissemination plans of our research.
Complete de-identified patient data set is available upon request for 3 years beyond publication.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Lasby, K., Sherrow, T., Fenton, T. et al. Very-low-birth-weight infant short-term post-discharge outcomes: A retrospective study of specialized compared to standard care. Matern Child Health J 27, 487–496 (2023). https://doi.org/10.1007/s10995-022-03517-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-022-03517-z