Abstract 591 Health Services Research: Quality Platform, Saturday, 5/1

Research question/objectives: Is there a difference in breastfeeding frequency, infant weight gain, maternal anxiety, or satisfaction with services, for singleton infants or their mothers discharged within 36 hours postpartum who received either: community health (home visit) follow-up or hospital (clinic) follow-up?

Significance: Fiscal constraint has resulted in shorter postpartum hospital stays. Hospital postpartum care has sometimes been replaced with nurse home visitation. Hospital stays are also being replaced by outpatient clinic or office visits, or not replaced. Rigorous research assessing the relative effectiveness of follow-up strategies is largely absent.

Background: Detrimental effects of short stays include hospital readmissions for dehydration and malnutrition of 2-week old breastfed infants. Serious sequelae also include convulsions, hypoglycemia, focal neurological deficits, disseminated intravascular coagulation, and amputation. Unresolved infant jaundice, maternal and infant infection, maternal anxiety, and breastfeeding failure have also been reported. Many of these outcomes might be prevented by adequate breastfeeding frequency in the early postpartum period. In addition, controlled studies have shown the effectiveness of interventions directed at early breastfeeding support provided by nurses. We choose breastfeeding frequency as our main outcome of interest.

Design: Randomized controlled trial.

Setting: University teaching hospital (3700 births/year) and affiliated community health centers. Sampling procedures and participants: 586 women recruited (Jan. '97-Oct.'98) prior to discharge and randomized.

Interventions: Experimental: 48-hour postpartum telephone contact and 3-day nurse home visit. Control: 48-hour postpartum telephone contact and 3-day nurse hospital clinic visit.

Instruments and measurement: Breastfeeding frequency, infant weight gain, maternal anxiety, and service satisfaction assessed at 12-14 days postpartum. Outcome measures included daily diaries (with telephone reminders), weight at home, questionnaires (STAI, CSQ-8), and record review.

Results: No group differences were found in breastfeeding frequency [mean difference = 0.3 feeds per day (95% confidence interval -0.1, 0.4)], daily rate of infant weight gain [-1.3 g (-3.1, 1.5)], maternal anxiety [0.3 points (-0.7, 1.7)], or service satisfaction [-0.1 points (-0.9, 0.7)] based an intention-to-treat analyses.

Conclusions: In this first randomized controlled trial of 2 approaches to nursing-based follow-up (home vs hospital clinic visit) of infants discharged less than 36 hours old, equivalent breastfeeding and weight gain were found at 2-weeks of age. In this patient population, both alternatives appear associated with satisfactory outcomes in newborns.