27 - Implementation of the AAP Discharge Guidelines Reduces Unplanned Readmissions of Newborn Infants: A Single-Center Study

Publication Number: 2024.27

Jorge M. Lopez Da Re, AdventHealth for Children, Winter Park, FL, United States; William NMN. Oh, Women and Infants' Hospital, Barrington, RI, United States; Julie Pepe, AdventHealth for Children, Orlando, FL, United States

Background: Historically, pediatricians and family medicine physicians have been providing care in the mother-infant unit (MIU).  On July 1, 2022, the hospital adopted discharge protocols aligned with American Academy of Pediatrics (AAP) guidelines. In July 2023, it enhanced care with 24-hour clinical coverage, including a full-time neonatologist and neonatal nurse practitioners. AAP guidelines specify neonatal and parental competencies for discharge. On discharge, newborns should be able to show coordinated sucking, swallowing, and breathing during feeding, proper weight loss, and, for preterm or at-risk infants, passing car seat safety tests. In addition, parents must show proficiency in newborn care, which is monitored by nursing staff and neonatal nurse practitioners.
Standard hospital discharge (SHD) involves releasing newborns and mothers after a minimum postnatal period, classified as very early (within 24 hours post-birth), early (within 48 hours for vaginal delivery or 96 hours for cesarean), or late (beyond 48 hours for vaginal or 96 hours for cesarean). At AdventHealth, SHD for healthy newborns depends on delivery mode, gestational age, competencies, and clinical risk factors. Newborns with risk factors stay beyond 36 hours for monitoring. For term newborns (≥37 weeks without risk factors, SHD occurs at 24 hours for vaginal deliveries and 48 hours for cesareans.

Objective: To evaluate the effectiveness of implementing American Academy of Pediatrics (AAP) discharge guidelines in reducing unplanned hospital readmissions within 30 days post-discharge among term and late preterm newborns.

Design/Methods: Retrospective observational study analyzing unplanned readmissions at a single-center neonatal unit from January 1, 2021, to December 31, 2024. Data were compared before (January 1, 2021-June 30, 2022) and after (July 1, 2022-December 31, 2024) guideline implementation, with subgroup analysis for the period after addition of structured support (July 1, 2023-December 31, 2024).

Results: AAP guideline implementation was associated with a statistically significant reduction in unplanned readmission rates among term infants (0.66% vs. 0.33%; P=0.008). No reduction was evident among late preterm infants. Subgroup analysis showed further reductions post-structured support addition, though confounding by provider changes limits attribution.

Conclusion(s): The adoption of the AAP discharge guidelines, along with a structured process of mother and infant readiness , significantly decreased unplanned readmission rates among term newborns.

Table 1: Readmission Rates for Term and Late Preterm Infants Through the Emergency/Urgent Care Department or Direct NICU Admission.
*P-values from chi-square tests; *denotes P<0.05.

Table 2: Primary Diagnoses and Readmission Rates (per 100 Births) Among Readmitted Term and Late Preterm Infants.
*P-values from chi-square (term) or Fisher exact (late preterm) tests on rates; *denotes P<0.05.
"P=0.007* refers to overall readmission rate comparison for term infants; individual diagnosis P-values are for rates per 100 births."

Table 3: Demographic and Clinical Characteristics of the Maternal and Neonatal Study Population.
Continuous variables are presented as mean ± SD; categorical variables as n (%). P-values from t-tests (continuous) or chi-square/Fisher exact tests (categorical).