Home nurse visits improve newborn health

Having a nurse visit the home a few days after a woman has a baby reduces the number of newborns being readmitted to the hospital with jaundice or dehydration - and it saves money - according to a new study.

"The third or fourth day after delivery is the time when babies can get into trouble with jaundice and dehydration and the American Academy of Pediatrics and other groups recommend follow-up on these days," lead author Dr. Ian Paul, from Penn State Children's Hospital in Hershey, Pennsylvania, told AMN Health.

However, the reality is that infants are often not seen on these days, either "because the pediatrician is unaware of the recommendations, their office is too busy to squeeze in more babies on the appropriate day, or simply because the office is closed," Paul explained.

"People have been talking about home nursing visits as a way to improve follow-up," Paul noted, "but few studies have looked at whether such visits improve health outcomes and whether they are cost effective."

As reported in the medical journal Pediatrics, the researchers analyzed data from all babies who were born at the Hershey Medical Center between 2000 and 2002. Of the total, 326 received a home nurse visit and 2641 did not.

The rate of hospital readmission for jaundice or dehydration in the first 10 days of life was just 0.6 percent for the nurse-visit group compared with 2.8 percent for the non-nurse group. The corresponding rates for an emergency room visit in the first 10 days of life were 0 and 3.5 percent.

The average cost per child in the nurse group was $109.80 compared with $118.70 in the non-nurse group. That's because an ER visit and hospital admission typically cost around $400 and $4000, respectively, while a home nurse visit costs insurers about $85, the investigators note.

"A home nurse visit provides a bridge over the gap between nursery care and primary care," Paul said. "Such visits are already standard of care in England, many areas of Canada, and several other countries."

Still, Paul believes a forward-looking study is warranted to verify the current findings.

SOURCE: Pediatrics, October 2004.