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Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study.
BMJ Open. 2017 05 29; 7(5):e016050.BO

Abstract

OBJECTIVE

To identify the primary reasons for term admissions to neonatal units in England, to determine risk factors for admissions for jaundice and to estimate the proportion who can be cared for in a transitional setting without separation of mother and baby.

DESIGN

Retrospective observational study using neonatal unit admission data from the National Neonatal Research Database and data of live births in England from the Office for National Statistics.

SETTING

All 163 neonatal units in England 2011-2013.

PARTICIPANTS

133 691 term babies born ≥37 weeks gestational age and admitted to neonatal units in England.

PRIMARY AND SECONDARY OUTCOMES

Primary reasons for admission, term babies admitted for the primary reason of jaundice, patient characteristics, postnatal age at admission, total length of stay, phototherapy, intravenous fluids, exchange transfusion and kernicterus.

RESULTS

Respiratory disease was the most common reason for admission overall, although jaundice was the most common reason for admission from home (22% home vs 5% hospital). Risk factors for admission for jaundice include male, born at 37 weeks gestation, Asian ethnicity and multiple birth. The majority of babies received only a brief period of phototherapy, and only a third received intravenous fluids, suggesting that some may be appropriately managed without separation of mother and baby. Admission from home was significantly later (3.9 days) compared with those admitted from elsewhere in the hospital (1.7 days) (p<0.001).

CONCLUSION

Around two-thirds of term admissions for jaundice may be appropriately managed in a transitional care setting, avoiding separation of mother and baby. Babies with risk factors may benefit from a community midwife postnatal visit around the third day of life to enable early referral if necessary. We recommend further work at the national level to examine provision and barriers to transitional care, referral pathways between primary and secondary care, and community postnatal care.

Authors+Show Affiliations

Neonatal Data Analysis Unit, Imperial College London, London, UK.School of Health and Education, Department of Midwifery, Middlesex University, London, UK.Maternity and Newborn, NHS Improvement, London, UK.Neonatal Unit, University College London Hospital, London, UK.No affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28554938

Citation

Battersby, Cheryl, et al. "Term Admissions to Neonatal Units in England: a Role for Transitional Care? a Retrospective Cohort Study." BMJ Open, vol. 7, no. 5, 2017, pp. e016050.
Battersby C, Michaelides S, Upton M, et al. Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study. BMJ Open. 2017;7(5):e016050.
Battersby, C., Michaelides, S., Upton, M., & Rennie, J. M. (2017). Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study. BMJ Open, 7(5), e016050. https://doi.org/10.1136/bmjopen-2017-016050
Battersby C, et al. Term Admissions to Neonatal Units in England: a Role for Transitional Care? a Retrospective Cohort Study. BMJ Open. 2017 05 29;7(5):e016050. PubMed PMID: 28554938.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study. AU - Battersby,Cheryl, AU - Michaelides,Stephanie, AU - Upton,Michele, AU - Rennie,Janet M, AU - ,, Y1 - 2017/05/29/ PY - 2017/5/31/entrez PY - 2017/5/31/pubmed PY - 2018/4/10/medline KW - England KW - United Kingdom KW - admissions KW - babies KW - jaundice KW - newborn KW - term SP - e016050 EP - e016050 JF - BMJ open JO - BMJ Open VL - 7 IS - 5 N2 - OBJECTIVE: To identify the primary reasons for term admissions to neonatal units in England, to determine risk factors for admissions for jaundice and to estimate the proportion who can be cared for in a transitional setting without separation of mother and baby. DESIGN: Retrospective observational study using neonatal unit admission data from the National Neonatal Research Database and data of live births in England from the Office for National Statistics. SETTING: All 163 neonatal units in England 2011-2013. PARTICIPANTS: 133 691 term babies born ≥37 weeks gestational age and admitted to neonatal units in England. PRIMARY AND SECONDARY OUTCOMES: Primary reasons for admission, term babies admitted for the primary reason of jaundice, patient characteristics, postnatal age at admission, total length of stay, phototherapy, intravenous fluids, exchange transfusion and kernicterus. RESULTS: Respiratory disease was the most common reason for admission overall, although jaundice was the most common reason for admission from home (22% home vs 5% hospital). Risk factors for admission for jaundice include male, born at 37 weeks gestation, Asian ethnicity and multiple birth. The majority of babies received only a brief period of phototherapy, and only a third received intravenous fluids, suggesting that some may be appropriately managed without separation of mother and baby. Admission from home was significantly later (3.9 days) compared with those admitted from elsewhere in the hospital (1.7 days) (p<0.001). CONCLUSION: Around two-thirds of term admissions for jaundice may be appropriately managed in a transitional care setting, avoiding separation of mother and baby. Babies with risk factors may benefit from a community midwife postnatal visit around the third day of life to enable early referral if necessary. We recommend further work at the national level to examine provision and barriers to transitional care, referral pathways between primary and secondary care, and community postnatal care. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/28554938/Term_admissions_to_neonatal_units_in_England:_a_role_for_transitional_care_A_retrospective_cohort_study_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&amp;pmid=28554938 DB - PRIME DP - Unbound Medicine ER -