Newborn Morbidities and Health Charges
First-time, low-income mothers who deliver a healthy newborn are challenged with early hospital discharge usually within 24 to 48 hours after giving birth and have little routine follow up (Brown et al., 2009; Sadeh-Mestechkin, Walfisch, Zeadna, Shoham-Vardi, & Hallak, 2007). Due to shortened postpartum stays, the American Academy of Pediatrics (AAP) and the American College of Obstetrics and Gynecologists (ACOG) (2007) recommend that all infants receive follow-up care from an experienced clinician within 48 to 72 hours post-hospital discharge to prevent both infant and maternal morbidity and mortality. However, research indicates that only 30% of these infants receive the 72-hour post-hospital discharge follow up as recommended by the AAP and ACOG (Lansky et al., 2006; Madlon-Kay, 2011).
Infants born to mothers with low incomes have increased re-hospitalization rates (Agency of Healthcare Research and Quality [AHRQ], 2011a; Kozak, Lees, & DeFrances, 2006). Annually in the U.S., there are several million potentially preventable hospital admissions as well as inappropriate use of high-cost health care services (AHRQ, 2011b; Kruzikas et al., 2004). Many of these preventable admissions and higher cost services result from delayed and late care by the poor and uninsured (Anderson et al., 2006). With over four million births annually in the U.S., childbirth is the most common cause of hospitalization (U.S. Department of Health and Human Services [DHHS], Health Resources and Services Admini stration [HRSA], & Maternal and Child Health Bureau [MCHB], 2011). Following birth, some newborns become ill and require only an acute care visit, while others require rehospitalizations. The most common diagnoses for infant rehospitalization within the first 28 days of life are jaundice, dehydration, respiratory complications, feeding difficulties, urinary tract infection, diarrhea, and meningitis. Overall, the most common infant morbidity in the first year of life is respiratory illness (Paul, Lehman, Hollenbeak, & Maisels, 2006; Yorita, Holman, Sejvar, Steiner, & Schonberger, 2008)
In the neonatal period, the most expensive diagnoses for all children are prematurity, cardiac and circulatory birth defects, other birth defects, respiratory distress syndrome, and other neonatal respiratory problems (AHRQ, 2010). AHRQ (2011b) reported that hospital stays for infants under one year of age averaged a cost of $4,144. The aggregate cost for children's hospitalizations was $33.6 billion in 2009 (AHRQ, 2011b). However, the National Hospital Discharge Survey by the Centers for Disease Control and Prevention [CDC] extracts morbidity data for infants from hospital discharge information, emergency room visits, and urgent care visits. This information is not monitored by the vital statistics systems as the monitoring of infant mortality rates. The United States does not have a national infant morbidity surveillance system (Tomashek, Crouse, Lyasu, Johnson, & Flowers, 2006). However, this information is becoming increasingly important to develop and provide interventions to decrease infant morbidity and the associated increase in the cost of health care.
Literature Review
Early Hospital Discharge And Infant Morbidity
First-time, low-income mothers who deliver a healthy newborn are challenged with early hospital discharge usually within 24 to 48 hours after giving birth and have little routine follow up (Brown et al., 2009; Sadeh-Mestechkin, Walfisch, Zeadna, Shoham-Vardi, & Hallak, 2007). Due to shortened postpartum stays, the American Academy of Pediatrics (AAP) and the American College of Obstetrics and Gynecologists (ACOG) (2007) recommend that all infants receive follow-up care from an experienced clinician within 48 to 72 hours post-hospital discharge to prevent both infant and maternal morbidity and mortality. However, research indicates that only 30% of these infants receive the 72-hour post-hospital discharge follow up as recommended by the AAP and ACOG (Lansky et al., 2006; Madlon-Kay, 2011).
Infants born to mothers with low incomes have increased re-hospitalization rates (Agency of Healthcare Research and Quality [AHRQ], 2011a; Kozak, Lees, & DeFrances, 2006). Annually in the U.S., there are several million potentially preventable hospital admissions as well as inappropriate use of high-cost health care services (AHRQ, 2011b; Kruzikas et al., 2004). Many of these preventable admissions and higher cost services result from delayed and late care by the poor and uninsured (Anderson et al., 2006). With over four million births annually in the U.S., childbirth is the most common cause of hospitalization (U.S. Department of Health and Human Services [DHHS], Health Resources and Services Admini stration [HRSA], & Maternal and Child Health Bureau [MCHB], 2011). Following birth, some newborns become ill and require only an acute care visit, while others require rehospitalizations. The most common diagnoses for infant rehospitalization within the first 28 days of life are jaundice, dehydration, respiratory complications, feeding difficulties, urinary tract infection, diarrhea, and meningitis. Overall, the most common infant morbidity in the first year of life is respiratory illness (Paul, Lehman, Hollenbeak, & Maisels, 2006; Yorita, Holman, Sejvar, Steiner, & Schonberger, 2008)
Health Care Costs
In the neonatal period, the most expensive diagnoses for all children are prematurity, cardiac and circulatory birth defects, other birth defects, respiratory distress syndrome, and other neonatal respiratory problems (AHRQ, 2010). AHRQ (2011b) reported that hospital stays for infants under one year of age averaged a cost of $4,144. The aggregate cost for children's hospitalizations was $33.6 billion in 2009 (AHRQ, 2011b). However, the National Hospital Discharge Survey by the Centers for Disease Control and Prevention [CDC] extracts morbidity data for infants from hospital discharge information, emergency room visits, and urgent care visits. This information is not monitored by the vital statistics systems as the monitoring of infant mortality rates. The United States does not have a national infant morbidity surveillance system (Tomashek, Crouse, Lyasu, Johnson, & Flowers, 2006). However, this information is becoming increasingly important to develop and provide interventions to decrease infant morbidity and the associated increase in the cost of health care.
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