Researchers: Chen Stein Zamir¹, Deena Zimmerman¹, Michael Kaplan¹

Background: The first days of life require newborn physiologic adaptation. Well newborn hospitalization has been shortened to <=48 hours. Hyperbilirubinemia, dehydration and feeding difficulties lead to cases of hospital readmission. Recommendations include medical evaluation within 48-72 hours (Israel Neonatal Association) and assessment in a Maternal Child Health Center (MCHC) by 2 weeks of age (Ministry of Health).

Objectives: Assessment of percentage of newborns evaluated within 48-72 hours of hospital discharge, associated demographic variables and possible barriers to recommendation adherence.

Method: In-person interviews with mothers of infants <=3 months of age attending Jerusalem District MCHC. The questionnaire included demographic and health variables, first evaluation timing and, if relevant, the reasons for non-occurrence.

Findings: We interviewed 868 mothers (response rate 99.4%), mean age 29.6, native Israeli - 83.9%. Jewish (81.7%), Arab (18.3%), post-high school education (70%). Infant variables: 94% full-term, mean birthweight 3179+/-497 g. Median position number of child in family - 2. Evaluation of 35.9% within 72 hours, 84.7% within 14 days with differences in adherence by nationality and religion. Bilirubin testing adherence was 98%. Seven children were readmitted. There is lack of uniformity in discharge instructions and difficulty in arranging follow-up appointments.

Conclusions: There was partial adherence to recommended follow-up with good adherence to bilirubin testing. There is a need to reduce barriers to increase the percentage of children evaluated within 72 hours and for uniform newborn discharge instructions with an emphasis on the importance of early post-discharge evaluation.

Recommendations: Newborn discharge follow-up is important as it can prevent the complications of conditions such as neonatal jaundice, feeding difficulties and previously undetected physical examination findings on physical. This is the first study of first-week adherence to post-discharge follow up instructions. There is a need for a national program to improve newborn follow-up and the continuity of care.

Research end date: 11/2018