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12190 (172, 173, 174) Paper Presentation 3 – Considerations at Discharge
(172) Safely Securing and Transporting Premature and Low-Birth-Weight Infants
Jill Guercio , BSN RNC-NIC CPAN CCPSTI , White Plains Hospital Center, White Plains, NY
Abstract
Stated Purpose:
Motor vehicle injuries are the leading cause of death among children in the US. By ensuring that newborns are properly tested in their car seat and are correctly restrained while riding for the first time, you seize a unique opportunity with a pattern of compliance that can save lives.
Background and Importance of Topic:
The number of infants weighing less than 2500 grams being transported has grown dramatically. In a local study by a Inspection Station 1315 car seats were checked in a 1 year period and only 10 of them had been installed properly. Hospitals have a groundbreaking opportunity to provide the staff with the proper resources to help educate the parents about this lifesaving measure.
Description of What Will be Covered:
1. Define the difference between premature and low birth weight infants.
2. Discuss transitional issues related to an infant discharge, define Federal Motor Vehicle Safety Standard 213 and how it applies to infants.
3. Explain the American Academy of Pediatrics Guidelines on Safe Transportation of Premature and Low Birth Weight Babies.
4. Cite the process and importance of the Car Seat Challenge Test.
5. Define the nursing process needed to create a successful discharge and transportation program.
Future Directions:
Hospitals with newborn services should consult with a certified car seat expert to develop policies ensuring that every newborn is properly restrained on discharge. In addition, the neonatal community should urge the AAP for a standardized car seat challenge test. Becoming proactive in your unit and seeking out the resources in your community is the first step that NICU nurses can take to help shape our future practices.
Learning Objectives
1. Define the difference between premature and low birth weight infants.
2. Discuss transitional issues related to an infant discharge, define Federal Motor Vehicle Safety Standard 213 and how it applies to infants.
3. Explain the American Academy of Pediatrics Guidelines on Safe Transportation of Premature and Low Birth Weight Babies.
4. Cite the process and importance of the Car Seat Challenge Test.
5. Define the nursing process needed to create a successful discharge and transportation program.
Bibliography
1. National Highway Traffic Safety Adminstration. Child Passenger Safety (CPS). From www.nhtsa.dot.gov/trafficsafety.
2. Pilley E, McGuire W. Pre-discharge "Car Seat Challenge" for Preventing Morbidity and Mortality in Preterm Infants. From www.cochrane.org/reviews/en/ab005386.html.
3. Pediatrics Vol 104 No.4 (Oct1999), 986-987, AAP Safe Transportation of Newborns at Hospital Discharge. From aappolicy.aapublications.org/cgi/content/fall/pediatrics.
(173) Identification of Premature Infants with Risk Factors for Breast and Bottle Feeding Problems Upon Discharge From the NICU
Sharon Delaney, DNP CNS NNP PNP, University of Washington, Seattle, WA
Abstract
Discharge from the NICU is contingent upon the premature infant's ability to consume and tolerate the required nutrition necessary for adequate growth. Studies of feeding problems in premature infants demonstrate that feeding problems persist post NICU discharge. Recommendations can be made for strategies to address these feeding difficulties in follow-up post NICU discharge. The purpose of this study was to identify the prevalence of risk factors for breast and bottle feeding problems upon discharge from the NICU. Application of the Doctorate of Nursing Practice (DNP) role in identification and care of the high risk infant with breast or bottle feeding problems is also discussed. Results: A retrospective chart review (N = 120) identified four risk factors known to contribute to feeding problems in the premature infant at discharge or post-NICU discharge. These factors were: 1) male gender (56%); 2) gestational age thirty four weeks gestation or less (46%); 3) identified feeding problem (39%); and 4) maternal race (35% non-White). The most frequent feeding problems documented were suck, swallow and breathing (89%). Conclusion: This study identified the prevalence of risk factors for breast and bottle feeding problems upon discharge from the NICU. Furthermore, these results may provide useful information for the development of a NICU and follow-up feeding program. Based on this study, there appears to be a need for the DNP role in care of infants at risk for or with breast and bottle feedings problems.
Learning Objectives
1. Discuss the five feeding problems identified upon discharge from the NICU.
2. Identify four of the most prevalent risk factors for feeding problems following NICU discharge found in this study.
3. Describe the three main roles of the doctor of nursing practice (DNP) in identification and care of the infant with feeding problems upon NICU discharge.
Bibliography
Amaizu, N., Shulman, R.J., Schanler, R.J., & Lau, C. (2008). Maturation of oral feeding skills in preterm infants. Acta Paediatrica, 97, 61-67.
Furman, L., Combs, B.C., Alexander, A.D., & O’Riordan, M.A. (2008). Breast-feeding rates at an inner-city pediatric practice. Clinical Pediatrics, 47, 873-882.
McGrath, J.M., & Braescu, A.V. (2004). State of the science: Feeding readiness in the preterm infant. Journal of Perinatal-Neonatal Nursing, 18, 353-368.
Pickler, R.H., Best, A.M., Reyna, B.A., Wetzel, P.A., Gutcher, G.R. (2005). Prediction of feeding performance in preterm infants. Newborn Infant Nurs Rev. 5, 116-123.
(174) Readmission Rates, Reason, and Costs of NICU Graduates
Sharon Kirkby, MSN RN, Alere, Inc, Atlanta, GA
Abstract
Background: Infants discharged from the NICU have higher readmission rates than healthy newborns.
Purpose: Quantify readmission rasons and incidence for NICU graduates baased on gestational age (GA) wihtin 30 days post discharge
Research Questions: 1. What are primary reasons for readmission for NICU graduates? 2. By stratified GA groups, describe the incidence, timing, and costs associated with readmission.
Methods: Retrospective data analysis of surviving NICU graduates from June 2006-August 2009 from a large neonatal database. Infants were matched up with claims data for two health plans, one in California, and one in the Northeast section of the US for readmissions up to 30 days post NICU discharge. ICD-9 codes were used to determine reason for readmission. Groups were stratified by < 30 weeks, 30-33 weeks, 34-36 weeks and ≥37 weeks.
Results: 7432 infants were studied, 214 infants were readmitted within 30 days post dicharge (2.9%).
Results by GA group: incidence, mean days to readmission, mean cost of readmission and top reasons:
<30 weeks 6.08%, 13.6, $14,893, Respiratory, Infection, Apnea
30-33 weeks 3.3%, 12.0, $15,981, Respiratory, Apnea, GE reflux
34-26 weeks 2.2%, 11.9, $13,128, Respiratory, Infection,Dehydration
≥37 weeks 2.4%, 11.9, $21,266, Infection, Cardiac, Jaundice
Implications for Practice:
NIC graduates are at high risk for readmission. Increased teaching in the discharge planning process, close follow up athome with nursing visits and physician appointments, and awareness of readmissions post-discharge may impat the safety and health of these fragile infants.
Learning Objectives
1. Review literature on NICU readmission data.
2. Describe readmission results of NICU graduates from a national data set in two large areas of the United States.
3. Discuss nursing interventions and special follow-up needs to minimize readmissionsof the NICU graduate.
Bibliography
Escobar, G.J., Green, J.D., Hulac, P. et al. (2005). Rehospitalisation after birth hospitalisation: patterns among infants of all gestrations. Arch. Dis. Child, 90, 125-131.
Silber J. H., Lorch S.A., Rosenbaum P.R., et al. (2009) Time to send the preemie home? Additional maturity at discharge and subsequent healthcare costs and outcomes. Health Services Researhc, 444:444-463.
Smith, J.R., Donze, A., Schuller, L. (2007). An evidence-based review of hyperbilirubinemia in the late preterm infatn, with implications for practice: management, follow-up, and breastfeeding support. Neonatal Network, 26(6), 395-405.
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