177 - Impact of Baby Friendly Implementation on In-Hospital Safety and Cost Outcomes of Newborns

Poster Number: 177
Publication Number: 177.234

Emil Bielecki, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Andrew Berenz, Rush University, Chicago, IL, United States; Tricia J. Johnson, Rush University, Chicago, IL, United States; Aloka L. Patel, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Carrie Drazba, Rush Children's Hospital, Chicago, IL, United States; Paula A. Meier, Rush University Medical Center, Oak Park, IL, United States

Background: The Baby Friendly Hospital Initiative (BFHI) was enacted as a global strategy to implement the Ten Steps to Successful Breastfeeding. However, data are limited regarding safety and cost implications to the patient and healthcare system.

Objective: To assess in-hospital safety and cost outcomes of healthy newborns admitted before and after implementation of BFHI at a single academic tertiary care center.

Design/Methods: This retrospective study compared the in-hospital safety and hospital costs (adjusted for inflation) for healthy newborns born before (Aug 2012-13, Nf1687, “pre-BFHI”) and after (Aug 2016-17, Nf1708, “BFHI”) implementation of the BFHI. Inclusion criteria: birthweight ≥1800g and ≥35 weeks gestational age at birth. Exclusion criteria: newborns admitted directly to the Neonatal Intensive Care Unit (NICU), presence of congenital anomalies, and newborns diagnosed with neonatal abstinence syndrome. Secondary outcomes include length of hospital stay, and indication and rate of transfer to NICU. Data were retrieved from the electronic medical record and the hospital’s cost accounting system.

Results: Baseline characteristics were similar between groups with the exception of higher proportions of cesarean delivery and public insurance in the pre-BFHI era (Table 1). BFHI did not result in an increased proportion of infants transferred to NICU, but more infants were transferred due to specific policies related to the BFHI initiative (e.g., maternal inability to care for infant) (Table 2, Figure 1). After adjusting for baseline characteristics, there was no difference in length of stay or total cost between periods for all infants or for infants < 37 weeks GA. In a secondary analysis examining the interaction between period and transfer to NICU, infants not transferred to NICU had significantly lower total cost while infants transferred to NICU had significantly higher total cost after BFHI was implemented (data not shown).Conclusion(s): The implementation of BFHI at a tertiary academic medical center did not result in increased rates of NICU transfer or hospital costs for well appearing newborns. BFHI was associated with an increased rate of NICU transfer due to policy changes associated with the implementation of the initiative, specifically “rooming in” and removal of the “Well Baby Nursery”. Importantly, BFHI was not associated with higher rates of NICU transfer for hypoglycemia treatment. While differences in cost after implementation of BFHI for infants transferred to NICU may be due to changes in transfer indication, more research is needed to pinpoint the underlying reasons for these changes.
Table 1: Baseline Characteristics* Mann-Whitney, ** Chi-square test, *** independent samples t-test
Table 2: Outcomes and Hospital Cost*Chi-square test, ** independent samples t-test