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Research ArticleOriginal Research

Effect of Revised Nursery Orders on Newborn Preventive Services

Diane J. Madlon-Kay
The Journal of the American Board of Family Medicine November 2011, 24 (6) 656-664; DOI: https://doi.org/10.3122/jabfm.2011.06.110027
Diane J. Madlon-Kay
MD, MS
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    Figure 1.

    Change in compliance with American Academy of Pediatrics guidelines for mothers receiving antibiotics for suspected chorioamnionitis. CBC, complete blood count.

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    Figure 2.

    Change in compliance with American Academy of Pediatrics guidelines for mothers receiving intrapartum antibiotic prophylaxis (IAP) for group B streptococcal (GBS) disease. *P < .0001. †P < .005. CBC, complete blood count.

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    Table 1.

    Overview of Newborn Nursery Standardized Order Changes

    OutcomeOld Nursery OrdersNew Nursery Orders
    Hepatitis B virus vaccinationPhysicians must “opt in,” ie, specifically order the vaccinePhysicians must “opt out,” ie, specifically order that no vaccine be given
    Discharge follow-up recommendationsNo guidanceRecommendations based on infant's age at discharge, transcutaneous bilirubin result before discharge, and jaundice risk factors, including breastfeeding. Follow-up intervals based on AAP recommendations.4
    GBS disease preventionIf the mother was positive for GBS, infant's vital signs were measured more frequentlyFollow CDC recommendations including observation for 48 hours for many infants.2Orders differ from CDC guideline by requiring only complete blood counts, and not blood cultures, for certain infants.
    • GBS, group B streptococcal; AAP, American Academy of Pediatrics; CDC, Centers for Disease Control and Prevention.

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    Table 2.

    Infant and Parental Characteristics

    Statistic2007 (n = 434)2008 (n = 423)
    Infant Sex
    Malen (%)221 (51)208 (49)
    Birth weight (g)Mean (SD)3407 (510.7)3416 (505.6)
    Range1814–49901980–4884
    Singleton birthn (%)425 (98)415 (98)
    APGAR score at 1 minuteMean (SD)8 (1.4)8 (1.4)
    Range1 to 101 to 9
    APGAR score at 5 minutesMean (SD)9 (0.5)9 (0.5)
    Range5 to 104 to 10
    Method of birth
    Vaginaln (%)306 (71)297 (70)
    Assisted vaginaln (%)20 (5)14 (3)
    Caesarean sectionn (%)108 (25)112 (26)
    Length of stay (hours)Median (SD)54 (96.3)52 (60.5)
    Range13 to 175415 to 917
    <24n (%)1 (0.2)3 (1)
    24–47n (%)152 (35)158 (37)
    48–72n (%)160 (37)149 (35)
    >72n (%)121 (28)113 (27)
    Maternal age (years)Mean (SD)29 (6.1)29 (6.2)
    Range15 to 5015 to 46
    Maternal education (years)
    0–12n (%)195 (45)183 (43)
    13–16n (%)133 (31)135 (32)
    17+n (%)106 (24)105 (25)
    Maternal race
    Whiten (%)189 (44)214 (51)
    Blackn (%)127 (29)119 (28)
    American Indiann (%)19 (4)9 (2)
    Asiann (%)42 (10)47 (11)
    Othern (%)75 (17)47 (11)
    Unknownn (%)2 (0.5)4 (1)
    Paternal race
    Whiten (%)178 (41)199 (47)
    Blackn (%)142 (33)116 (27)
    American Indiann (%)9 (2)7 (2)
    Asiann (%)38 (9)42 (10)
    Othern (%)72 (17)50 (12)
    Unknownn (%)12 (3)24 (6)
    Father Hispanic
    Yesn (%)61 (14)51 (12)
    Non (%)349 (80)347 (82)
    Missingn (%)24 (6)25 (6)
    Mother Hispanic
    Yesn (%)67 (15)52 (12)
    Non (%)354 (82)366 (87)
    Missingn (%)13 (3)5 (1)
    Father birthplace
    United Statesn (%)229 (53)240 (57)
    Somalian (%)56 (13)46 (11)
    Othern (%)149 (34)137 (32)
    Mother birthplace
    United Statesn (%)251 (58)267 (63)
    Somalian (%)60 (14)51 (12)
    Othern (%)123 (28)105 (25)
    Prenatal visitsMean (SD)10.3 (3.2)10.7 (3.0)
    Range1 to 240 to 21
    EGA (weeks)Mean (SD)39.4 (1.3)39.4 (1.5)
    Range35.3 to 42.335 to 43.6
    Maternal diabetesn (%)40 (9)34 (8)
    • EGA, estimated gestational age.

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    Table 3.

    Discharge Follow-up Recommendations

    20072008
    LOS <24 hoursn = 1n = 3
    Clinic follow-up (days)
    1–5*1 (100)2 (67)
    ≥7†00
    LOS 24–47 hoursn = 152n = 155
    Clinic follow-up (days)
    1 to 5*130 (86)140 (90)
    ≥7†9 (6)8 (5)
    LOS 48–72 hoursn = 151n = 138
    Clinic follow-up (days)
    1–5*129 (85)120 (87)
    ≥7†10 (7)9 (7)
    LOS >72 hoursn = 90n = 81
    Clinic follow-up (days)
    1–5*69 (77)74 (91)
    ≥7†10 (11)3 (4)
    All‡n = 394n = 377
    Clinic follow-up
    1–5*329 (84)336 (89)
    ≥7†29 (7)20 (5)
    • ↵* Twenty-four hours, 48 hours, 2 to 3 days, or others that were <4 days for 2008; 2 to 5 days or others that were <3 days for 2007.

    • ↵† Others that were at least 7 days for 2008; 7 to 14 days or others that were at least 7 days for 2007.

    • ↵‡ Fisher's exact test; P = .24.

    • LOS, length of stay.

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The Journal of the American Board of Family     Medicine: 24 (6)
The Journal of the American Board of Family Medicine
Vol. 24, Issue 6
November-December 2011
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Effect of Revised Nursery Orders on Newborn Preventive Services
Diane J. Madlon-Kay
The Journal of the American Board of Family Medicine Nov 2011, 24 (6) 656-664; DOI: 10.3122/jabfm.2011.06.110027

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Effect of Revised Nursery Orders on Newborn Preventive Services
Diane J. Madlon-Kay
The Journal of the American Board of Family Medicine Nov 2011, 24 (6) 656-664; DOI: 10.3122/jabfm.2011.06.110027
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