Introduction: Hospital readmissions and emergency department (ED) visits account for the largest proportion of Canadian healthcare costs in the first 6-months post birth-discharge for full-term infants, and are attributed primarily to jaundice, dehydration and feeding problems. Postpartum breastfeeding difficulties are common (86%) and can lead to morbidity in mothers (nipple trauma, infection, psychological distress) and infants (dehydration, poor weight gain, malnutrition), however, their association with ED use and readmission remain unexplored.
Methods: We conducted a secondary analysis of prospective birth-cohort data from Calgary, Alberta. We extracted data on breastfeeding difficulties (measured at delivery and 6 weeks postpartum), self-reported ED use and readmission up to six months postpartum. We used logistic regression to assess the associations between breastfeeding difficulties and maternal and infant ED use, and readmissions controlling for confounding as appropriate.
Results: Our sample contained all 446 mother-infant dyads in the cohort. Eighty-one percent (n=362) of mothers reported “moderate” to “severe” breastfeeding difficulties within 72-hours of delivery, 80% (n=290) of whom had difficulties that persisted after discharge. Infants of mothers with persistent breastfeeding difficulties had significantly higher odds of ED use (OR 2.4, 95% CI: 1.53-5.00, p=0.019) and hospital readmissions (3.1% vs. 0.8%, p<0.001) in the first 6 months, relative to infants of those without difficulties, while controlling for parity and socioeconomic status. Maternal ED use and readmissions were not significantly associated with breastfeeding difficulties.
Conclusion: While readmissions are often necessary, the identification and prevention of avoidable ED visits and readmissions can improve maternal and infant health outcomes and reduce healthcare costs. A focus on services and supports that can ensure the resolution of early breastfeeding difficulties may help to reduce infant ED use and readmissions.
Katie Chaput– Assistant Professor, Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB
Jessica-Lynn Walsh– Graduate Student, University of Calgary
Amy Metcalfe– Associate Professor, University of Calgary
Suzanne Tough– Professor, Department of Paediatrics, University of Calgary, Calgary, AB