Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study

Article


Battersby, C., Michaelides, S., Upton, M. and Rennie, J. 2017. Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study. BMJ Open. 5 (7). https://doi.org/10.1136/bmjopen-2017-016050
TypeArticle
TitleTerm admissions to neonatal units in England: a role for transitional care? A retrospective cohort study
AuthorsBattersby, C., Michaelides, S., Upton, M. and Rennie, J.
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.

Sustainable Development Goals4 Quality education
3 Good health and well-being
Middlesex University ThemeHealth & Wellbeing
LanguageEnglish
PublisherBMJ Publishing Group
JournalBMJ Open
ISSN2044-6055
Publication dates
Print29 May 2017
Online29 May 2017
Publication process dates
Accepted05 Apr 2017
Submitted26 Jan 2017
Deposited17 Nov 2023
Output statusPublished
Publisher's version
License
Copyright Statement

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Digital Object Identifier (DOI)https://doi.org/10.1136/bmjopen-2017-016050
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