168 - Hepatitis B Birth Dose Vaccination Improvement Initiative: The 24-Hour Baby Bundle

Poster Number: 168
Publication Number: 168.233

Kaeli Heidenreich, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Shannon Dunne, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Hayley Gillespie, Prentice Women's Hospital, Chicago, IL, United States; Amanda Chang, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; James L. Burns, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Malika Shah, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States

Background:
An estimated 25,000 infants are born to mothers diagnosed with hepatitis B virus (HBV) each year in the United States, with approximately 1,000 transmitting HBV to their infants. Administration of the birth dose HBV vaccine not only prevents perinatal transmission but is also associated with improved subsequent vaccine compliance. Though national guidelines promote vaccination within 24 hours of birth, fewer than 70% of infants receive the dose in the first 3 days of life. To improve compliance with national recommendations, Northwestern Medicine implemented the 24-Hour Baby Bundle (24-HBB), a cluster care initiative.

 

Objective:
Evaluate the 24-HBB’s effect on HBV vaccine administration within 24 hours of life. Examine 24-HBB’s efficacy across racial and ethnic groups.  

 

Design/Methods:
Retrospective cohort study approved by Northwestern IRB (STU00214975). Data abstracted through Northwestern Enterprise Data Warehouse and totaled 32,279 infants born at Prentice Women’s Hospital. Exclusion criteria included infant demise, birthweight less than 2000 grams, and NICU admission. Pre-intervention birthdates 2/16/2019-1/16/2020 and post-intervention birthdates 3/17/2020 – 2/16/2021, with a 2-month washout education period between 1/17/2020 – 3/16/2020. The 24-HBB was implemented 2/17/2020 and included initiating cluster care at 23 hours beginning with HBV vaccine, followed by bath, weight, metabolic screening, and ending with congenital heart disease screening. Pearson chi-squared analysis was conducted to statistically analyze differences in HBV vaccine pre and post intervention.

 

Results:
Pre and post intervention demographics remained consistent, except for mothers that identified as Asian, Native Hawaiian/Pacific Islander, and multiracial (Table 1). HBV vaccination rates prior to discharge did not change (96.2 to 96.4%, NS). HBV vaccination within 24 hours increased from 57 to 76% (p < 0.01, Figure 1a), and was significant in all racial groups, with the largest increase amongst the Asian population (55.3 to 77.38%, p< .01, Figure 1b). Refusal of vitamin K correlated with HBV vaccine refusal both pre and post intervention with 59.8% of parents refusing vitamin K also refusing HBV vaccine (Figure 2).

 Conclusion(s):
The 24-HBB is effective at increasing rates of HBV vaccination within 24 hours of birth. Newborn nurseries may benefit from similar cluster care initiatives to satisfy national recommendations, prevent hepatitis B infection, and promote childhood vaccination compliance. Further research is needed to address vaccine hesitancy and to investigate outcomes of other components of cluster care.

 
Table 1. Background Characteristics of Study Population
Figure 1a. Percentage of infants vaccinated within 24 hours by month Figure 1b. Pre and Post Implementation of 24-HBB Improvement by Racial Groups