Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding

Valerie Flaherman, Eric W. Schaefer, Michael W. Kuzniewicz, Sherian X. Li, Eileen M. Walsh, Ian Paul

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Guidelines recommend closer outpatient follow-up for exclusively breastfed newborns, especially those with pronounced weight loss, because of increased risk of hyperbilirubinemia and dehydration that might require readmission. Our objective was to determine how feeding method and weight loss are associated with neonatal health care utilization. Methods: A retrospective cohort study conducted at Northern California Kaiser Permanente hospitals in 2009–2013 assessed 143,889 neonates to study the inpatient method of feeding as well as inpatient and outpatient weights. The main outcome measures were inpatient and outpatient health care utilization in the 30 days after birth. Results: Newborn weight loss and feeding method were both associated with utilization. Exclusively breastfed newborns had higher readmission rates than those exclusively formula fed for both vaginal (4.3% compared to 2.1%) (P <.001) and cesarean deliveries (2.1% compared to 1.5%) (P =.025). Those exclusively breastfed also had more neonatal outpatient visits compared to those exclusively formula fed for both vaginal (means of 3.0 and 2.3, P <.001) and cesarean deliveries (means of 2.8 and 2.2, P <.001). Among vaginally delivered newborns of all feeding types, newborns with weight loss >10% at discharge had a relative risk of readmission of 1.10 (95% confidence interval [CI],1.00, 1.20) compared to those with <8% weight loss at discharge; among the subset weighed as inpatients or outpatients between 48 and 72 hours, those with >10% weight loss between 48-72 hours had a relative risk of readmission of 2.11 (95% CI, 1.95, 2.26) compared to those with <8% weight loss at 48-72 hours. Conclusions: Exclusive breastfeeding and weight loss are associated with increased neonatal health care utilization. Improving clinical management of exclusively breastfed neonates with pronounced weight loss might reduce health care utilization.

Original languageEnglish (US)
Pages (from-to)677-684
Number of pages8
JournalAcademic Pediatrics
Volume18
Issue number6
DOIs
StatePublished - Aug 1 2018

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Patient Acceptance of Health Care
Feeding Methods
Weight Loss
Parturition
Newborn Infant
Inpatients
Outpatients
Confidence Intervals
Hyperbilirubinemia
Ambulatory Care
Breast Feeding
Dehydration
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Guidelines
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Flaherman, Valerie ; Schaefer, Eric W. ; Kuzniewicz, Michael W. ; Li, Sherian X. ; Walsh, Eileen M. ; Paul, Ian. / Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding. In: Academic Pediatrics. 2018 ; Vol. 18, No. 6. pp. 677-684.
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abstract = "Objective: Guidelines recommend closer outpatient follow-up for exclusively breastfed newborns, especially those with pronounced weight loss, because of increased risk of hyperbilirubinemia and dehydration that might require readmission. Our objective was to determine how feeding method and weight loss are associated with neonatal health care utilization. Methods: A retrospective cohort study conducted at Northern California Kaiser Permanente hospitals in 2009–2013 assessed 143,889 neonates to study the inpatient method of feeding as well as inpatient and outpatient weights. The main outcome measures were inpatient and outpatient health care utilization in the 30 days after birth. Results: Newborn weight loss and feeding method were both associated with utilization. Exclusively breastfed newborns had higher readmission rates than those exclusively formula fed for both vaginal (4.3{\%} compared to 2.1{\%}) (P <.001) and cesarean deliveries (2.1{\%} compared to 1.5{\%}) (P =.025). Those exclusively breastfed also had more neonatal outpatient visits compared to those exclusively formula fed for both vaginal (means of 3.0 and 2.3, P <.001) and cesarean deliveries (means of 2.8 and 2.2, P <.001). Among vaginally delivered newborns of all feeding types, newborns with weight loss >10{\%} at discharge had a relative risk of readmission of 1.10 (95{\%} confidence interval [CI],1.00, 1.20) compared to those with <8{\%} weight loss at discharge; among the subset weighed as inpatients or outpatients between 48 and 72 hours, those with >10{\%} weight loss between 48-72 hours had a relative risk of readmission of 2.11 (95{\%} CI, 1.95, 2.26) compared to those with <8{\%} weight loss at 48-72 hours. Conclusions: Exclusive breastfeeding and weight loss are associated with increased neonatal health care utilization. Improving clinical management of exclusively breastfed neonates with pronounced weight loss might reduce health care utilization.",
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Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding. / Flaherman, Valerie; Schaefer, Eric W.; Kuzniewicz, Michael W.; Li, Sherian X.; Walsh, Eileen M.; Paul, Ian.

In: Academic Pediatrics, Vol. 18, No. 6, 01.08.2018, p. 677-684.

Research output: Contribution to journalArticle

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AB - Objective: Guidelines recommend closer outpatient follow-up for exclusively breastfed newborns, especially those with pronounced weight loss, because of increased risk of hyperbilirubinemia and dehydration that might require readmission. Our objective was to determine how feeding method and weight loss are associated with neonatal health care utilization. Methods: A retrospective cohort study conducted at Northern California Kaiser Permanente hospitals in 2009–2013 assessed 143,889 neonates to study the inpatient method of feeding as well as inpatient and outpatient weights. The main outcome measures were inpatient and outpatient health care utilization in the 30 days after birth. Results: Newborn weight loss and feeding method were both associated with utilization. Exclusively breastfed newborns had higher readmission rates than those exclusively formula fed for both vaginal (4.3% compared to 2.1%) (P <.001) and cesarean deliveries (2.1% compared to 1.5%) (P =.025). Those exclusively breastfed also had more neonatal outpatient visits compared to those exclusively formula fed for both vaginal (means of 3.0 and 2.3, P <.001) and cesarean deliveries (means of 2.8 and 2.2, P <.001). Among vaginally delivered newborns of all feeding types, newborns with weight loss >10% at discharge had a relative risk of readmission of 1.10 (95% confidence interval [CI],1.00, 1.20) compared to those with <8% weight loss at discharge; among the subset weighed as inpatients or outpatients between 48 and 72 hours, those with >10% weight loss between 48-72 hours had a relative risk of readmission of 2.11 (95% CI, 1.95, 2.26) compared to those with <8% weight loss at 48-72 hours. Conclusions: Exclusive breastfeeding and weight loss are associated with increased neonatal health care utilization. Improving clinical management of exclusively breastfed neonates with pronounced weight loss might reduce health care utilization.

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