Date of Graduation

5-2018

Document Type

Thesis

Degree Name

Bachelor of Science in Nursing

Degree Level

Undergraduate

Department

Nursing

Advisor/Mentor

Scott, Allison

Committee Member/Reader

Vowell-Johnson, Kelly

Committee Member/Second Reader

Ballentine, Hope

Abstract

Abstract

Background:

In the U.S., late preterm (LP) births, which occur at 340/7-366/7 weeks gestation, make up the largest and fastest-growing group of preterm births. Although there is a trend of increased rates of LP infant readmissions compared to term infant readmissions, the relationship between LP infant morbidities and method of feeding has not been extensively studied.

Objective:

The purposes of this study were to 1) identify the primary causes of LP infant hospital readmissions and, 2) correlate the primary causes of LP infant hospital readmissions with the method of feeding.

Methods:

The design of this nonexperimental study was a retrospective chart review identifying the primary diagnosis, and method of feeding, of term and LP infants readmitted to the medical or pediatric unit of a Northwest Arkansas hospital between the dates of May 1, 2015 and July 31, 2017. A total of 114 charts were reviewed, of which 17 LP infants met the study inclusion criteria. All infants were breastfed or formula-fed as their only source of nutrition. Term infants served as the control sample. Those infants transported from another level III tertiary neonatal unit were excluded, as well as infants aged 6 months or older at the time of readmission. The outcome measure was a comparison of nutritive and non-nutritive readmission diagnoses, with the focus of the nutritive readmission diagnoses placed on whether the infant was formula-fed or breastfed. A Cochran-Mantel-Haenszel was calculated to determine whether there was a relationship between the infants’ readmission diagnoses and feeding methods when controlling for gestational age.

Results:

A Breslow-Day Test for Homogeneity of the Odds Ratios demonstrated statistically significant differences between primary cause of readmission and the method of feeding, χ2(1) = 5.7453, p = .0165. The Cochran-Mantel-Haenszel was significant, CMH (1) = 13.9886, p = .002, indicating there was a relationship between the readmission diagnosis and feeding method when controlling for gestational age. While only 11.1% of breastfed LP infants were readmitted for non-nutritive reasons, 88.89% of breastfed LP infants were readmitted for nutritive reasons. One hundred-percent of formula-fed LP infants were readmitted for non-nutritive reasons.

Conclusion:

This study revealed breastfeeding LP infants were more likely to be readmitted with nutritive diagnoses, with hyperbilirubinemia accounting for 75% of those readmissions. Formula-fed LP infants were more frequently readmitted with non-nutritive diagnoses, with 62.5% of those diagnoses being bronchiolitis caused by respiratory syncytial virus (RSV). Although breastfeeding is linked to increased incidences of hyperbilirubinemia, inadequate breastfeeding may play a significant role in further increasing bilirubin levels in LP infants. From this study, an intervention aimed at improving breastfeeding outcomes and preventing hyperbilirubinemia from a nursing and lactation standpoint, such as with the implementation of a discharge readiness assessment checklist, may prove beneficial in reducing readmission rates of LP infants related to breastfeeding.

Keywords

lactation; lactation consultant

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