Key result
Six risk factors were consistently associated with 31-day unplanned hospital readmissions in newborns: primiparous mother, Asian maternal ethnicity, vaginal delivery, maternal complications, male infant, and neonatal comorbidities.
Why the study?
Attempts have been made to identify risk factors associated with newborn unplanned hospital readmissions, but the results have been inconsistent.
Systematic Review
Maternal factors (primiparity, Asian ethnicity, vaginal delivery, complications) and neonatal factors (male sex, comorbidities) are consistently associated with 31-day unplanned hospital readmission in newborns, highlighting the need for individualized discharge readiness assessments.
May inform risk-stratified newborn discharge planning; supports prospective validation of these factors.
The purpose of this study is to synthesize evidence on risk factors associated with newborn 31-day unplanned hospital readmissions (UHRs). A systematic review was conducted searching CINAHL, EMBASE (Ovid), and MEDLINE from January 1st 2000 to 30th June 2021. Studies examining unplanned readmissions of newborns within 31 days of discharge following the initial hospitalization at the time of their birth were included. Characteristics of the included studies examined variables and statistically significant risk factors were extracted from the inclusion studies. Extracted risk factors could not be pooled statistically due to the heterogeneity of the included studies. Data were synthesized using content analysis and presented in narrative and tabular form. Twenty-eight studies met the eligibility criteria, and 17 significant risk factors were extracted from the included studies. The most frequently cited risk factors associated with newborn readmissions were gestational age, postnatal length of stay, neonatal comorbidity, and feeding methods. The most frequently cited maternal-related risk factors which contributed to newborn readmissions were parity, race/ethnicity, and complications in pregnancy and/or perinatal period. CONCLUSION: This systematic review identified a complex and diverse range of risk factors associated with 31-day UHR in newborn. Six of the 17 extracted risk factors were consistently cited by studies. Four factors were maternal (primiparous, mother being Asian, vaginal delivery, maternal complications), and two factors were neonatal (male infant and neonatal comorbidities). Implementation of evidence-based clinical practice guidelines for inpatient care and individualized hospital-to-home transition plans, including transition checklists and discharge readiness assessments, are recommended to reduce newborn UHRs. WHAT IS KNOWN: • Attempts have been made to identify risk factors associated with newborn UHRs; however, the results are inconsistent. WHAT IS NEW: • Six consistently cited risk factors related to newborn 31-day UHRs. Four maternal factors (primiparous, mother being Asian, vaginal delivery, maternal complications) and 2 neonatal factors (male infant and neonatal comorbidities). • The importance of discharge readiness assessment, including newborn clinical fitness for discharge and parental readiness for discharge. Future research is warranted to establish standardised maternal and newborn-related variables which healthcare providers can utilize to identify newborns at greater risk of UHRs and enable comparison of research findings.
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Della et al. (2023) conducted a systematic review in Newborns at risk of 31-day unplanned hospital readmission. Maternal and neonatal risk factors vs. Absence of risk factors was evaluated on 31-day unplanned hospital readmission (UHR). Six risk factors were consistently associated with 31-day unplanned hospital readmissions in newborns: primiparous mother, Asian maternal ethnicity, vaginal delivery, maternal complications, male infant, and neonatal comorbidities.
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