BRIEF REPORT

Evaluating Educational Needs of Parents atNewborn Discharge: A Pilot StudyAlanna Staiman, Brendan D. Crawford, MD, Kyle K. McLain, BA, Theresa B. Gattari, BA, Kerry P. Mychaliska, MD

A B S T R A C TOBJECTIVE: The delivery of anticipatory guidance regarding newborn care is a standard practicefor pediatricians. The purpose of this prospective study was to analyze the preexisting knowledge ofroutine newborn care in postpartum mothers.

METHODS: Inclusion criteria included all postpartum mothers of live-born infants at least twohours following delivery that had not yet received formal instruction in newborn care. Each eligiblemother that agreed to the voluntary survey was asked four multiple-choice questions which evaluatedher knowledge of newborn care. The four questions addressed knowledge of safe sleep, car seatposition, feeding behavior, and neonatal fever. A standardized template was used to ensure validity.Results were recorded in Microsoft Excel.

RESULTS: Of the study population, 42% (55/131) of surveyed mothers were first-time mothers.Overall, results of the survey demonstrated that postpartum mothers answered the surveyedquestions correctly 88% of the time previous to receiving anticipatory guidance.

CONCLUSIONS: Postpartum mothers appear to have a high preexisting knowledge of routinenewborn care in this study. Further studies are needed to determine if postpartum mothers’knowledge base increases with inpatient education.

Department of Pediatricsand Communicable

Diseases, The Universityof Michigan Medical

School, C.S. MottChildren’s Hospital, Ann

Arbor, Michigan

www.hospitalpediatrics.orgDOI:10.1542/hpeds.2015-0197Copyright © 2016 by the American Academy of Pediatrics

Address correspondence to Kerry P. Mychaliska, MD, Department of Pediatrics, C.S. Mott Children’s Hospital, Mott 12-5251540 EastHospital Dr, SPC 4280 Ann Arbor MI, 48109. E-mail: mkerry@med.umich.edu

HOSPITAL PEDIATRICS (ISSN Numbers: Print, 2154-1663; Online, 2154-1671).

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

FUNDING: No external funding.

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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The hospital stay of the mother and herhealthy term newborn infant should be longenough to allow identification of earlyproblems and to ensure that the family isable and prepared to care for the infant athome.1 According to the American Academyof Pediatrics (AAP) guideline, the dischargereadiness checklist includes a normalphysical examination, 2 successful feedingsof the infant, sleep schedules, when tobathe, the mother’s knowledge andconfidence to provide adequate care forher infant, and a safe home environment.2

At many academic medical centers,standard practice also involves a dischargediscussion that traditionally covers feeding,elimination, bathing and umbilical cordcare, sleep habits, and injury prevention.1

Early newborn discharge, the practice ofdischarging newborns and mothers fromthe hospital at ,48 hours after delivery,resulted in one of the most widely discussedpublic policy changes affecting pediatrics inthe past decade.3 Although mother-infantdyads used to remain inpatient for severaldays after the birth of the infant, theyare now being discharged much earlier.In the western United States, stays of 12to 24 hours or less after uncomplicatedvaginal birth and 48 to 72 hours afteruncomplicated cesarean delivery are nowstandard.4 With early newborn discharges,the same number of tasks recommended bythe AAP need to be performed in a shorterperiod of time, requiring that we use thattime in the best way possible to prepare thefamily for discharge home.

The purpose of our study was to examinemothers’ preexisting knowledge of newborncare to better determine the needs ofanticipatory guidance via an educationaltalk during a short inpatient newborn stay.

METHODS

The Institutional Review Board at theUniversity of Michigan Medical School(IRBMED) HUM00059494 approved thisHealth Insurance Portability and AccountabilityAct–compliant study. This 12-monthprospective study collected data at theUniversity of Michigan C.S. Mott Children’sHospital in Ann Arbor, Michigan onweekdays, including weekends. Inclusioncriteria included any English-speaking

inpatient mother who gave birth to alive infant, was admitted to the hospitalnewborn medicine service, and was.2 hours postpartum. Exclusion criteriaincluded any inpatient mother who wasnon-English speaking, had already receiveda newborn educational talk by a member ofthe pediatric team, as well as newbornsadmitted to private community pediatriciansor transferred to the NICU. Informedconsent was obtained from all mothers;participation was strictly voluntary.

Each day, a member of the study teamidentified eligible mothers via TraceVue(Koninklijke Philips Electronics N.V., Germany),an electronic medical system that records thedate and time of every newborn’s birth, as wellas all demographic information and patientlocation. A study team member obtainedconsent from eligible mothers. If mothers wereunavailable, a study team member returned ata later time, making a maximum of 3 attempts.

Each consented mother was administered astandardized 4-question survey designed toassess her infant care knowledge (Fig 1).The survey was scripted and included anintroduction and the purpose of the study.These 4 questions were chosen as they weredetermined to present the greatest risk tothe neonate if the parents were uneducatedon these topics: proper car seat usage,sleep positioning, fever threshold (definedas 100.4°F/38°C), and proper feedingintervals during the first week of life.

The verbal answers recorded by hand on thepaper survey sheets were then transferred toa Microsoft Excel (Microsoft, Redmond, WA)spreadsheet. The data were analyzed andpresented as descriptive statistics. A furthersubanalysis related to the mother’s parity wasperformed in the same manner. A x2 test wasconducted to evaluate the statisticaldifference in question responses betweenprimiparous and multiparous mothers.

RESULTS

During the 12-month study period, 131postpartum mothers were determined eligibleand informed consent was obtained. Fifty-five(42%) of the 131 surveyed mothers werefirst-time mothers.

Overall, 461 (88%) of 524 questions wereanswered correctly; individual question

responses answered correctly are presentedin Fig 2. A subanalysis of the data lookingspecifically at primiparous and multiparousmothers is also included in Fig 2. A x2 testcomparing multiparous (n 5 76) andprimiparous (n 5 55) mothers’ correctresponses to the 4 survey questions revealedno statistically significant difference in theirresponses (P 5 .8118).

Our study population was a random sample;however, demographic data of allpostpartum mothers during our studyperiod at C.S. Mott Children’s Hospital arerecorded in Table 1.

DISCUSSION

The immediate newborn period representsa critical time for recovery and formationof newborn infant feeding practices.Therefore, providers should be thoughtfulas to how this postpartum hospital time isused. This study examined mothers’preexisting knowledge of newborn care tobetter determine the needs of anticipatoryguidance via an educational talk in theinpatient newborn hospital setting. Thisprospective study demonstrated that, overall,mothers possess infant care knowledgeregarding safe sleep position, car seat safety,newborn feeding behavior, and neonatalfever 88% of the time before receivinginpatient newborn education. Given the highbackground knowledge observed in thissurvey study, the necessity of giving aneducational discharge talk to mothers duringtheir brief postpartum hospitalization mayneed to be reconsidered.

The AAP policy statement on hospital staysfor healthy term newborns states that thepediatrician’s primary role is to ensurethe health and well-being of the infant in thecontext of the family.1 As such, the policyrecommends that 17 minimum criteria aremet before discharge of a term newborn,defined as an infant born between 37-0/7 and41-6/7 weeks of gestation5 after anuncomplicated pregnancy, labor, anddelivery. In terms of maternal education,the policy recommends that the providersdocument the mother’s knowledge, ability,and confidence to provide adequate carefor her newborn in 7 specific areas:breastfeeding, urination/stooling,umbilical cord care, temperature

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assessment, signs of illness, infant safety,and hand hygiene.5 The policy does not,however, provide specific guidelinesregarding content, timing, or mode ofdelivery. In examining how to accomplishthis recommendation, the literature wasreviewed. Currently available literatureprovides little scientific evidence to guidedischarge planning for most apparentlywell newborns and their mothers.4

Cochrane Review6 (2013) assessed theeffects of postnatal education related togeneral infant health and concluded that

the benefits of educational programs toparticipants and their newborns remainunclear. In contemporary times, providingpreventive advice is called anticipatoryguidance, and it is an integral part ofwell-child care.7 Anticipatory guidance isthe cornerstone of child healthsupervision, and along with growth/development, monitoring, andimmunizations, it forms the core ofpediatric prevention.8 Schuster et al7

reported that parents value anticipatoryguidance and most parents in their study

would be willing to pay for moreinformation. This observation supportsthe idea that parents like clinicians toprovide anticipatory guidance. Althoughcurrent literature suggests thatpediatricians and parents agreeanticipatory guidance is important,7 theydo require an element of time9 and maynot be most effectively relayed during ashort, busy inpatient hospitalization. Ittakes time to cover multiple aspects ofanticipatory guidance and to answerparents’ follow-up questions.9

FIGURE 1 “Neonatal Anticipatory Guidance” survey.

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Nevertheless, it behooves providers tofind the best mechanism to provide thisinformation, as anticipatory guidance hasbeen shown to improve health outcomes8

and it has the potential to completelychange the course of a patient’s care.10

Like any study, our project had limitations.For our study patient population, maritalstatus, age, and race were not self-reported.This may have limited the generalizability ofour results. However, demographic data ofall postpartum mothers during our studyperiod at C.S. Mott Children’s Hospital andVon Voigtlander Women’s Hospital wereobtained and reported. Second, newbornbirth times were variable; whether birthtime affected a mother’s ability to answerquestions correctly was not addressed inthis study. Third, in the current climate ofshort hospital stays, it is a challenge forhealth care providers to accomplish all ofthe postpartum newborn care. Dischargetalks given by a health care provider werenot timed during this study; therefore, it isnot possible to report whether the length ofthe talk negatively affected the inpatientnewborn hospital stay. Furthermore, therewere 2 problems with the phrasing of thefinal survey question regarding neonatalfever threshold. First, the question waswritten in Fahrenheit and some motherspreferred Celsius. Second, due to poorwording, all mothers reported an answerthat demonstrated they would call theirpediatrician either at or below thetemperature of a neonatal fever. Due tothe structure of the question, we createda situation in which we could not assessif some mothers had a threshold forcalling the pediatrician at a temperature.100.4°F.

Last, future studies are needed to examinewhether inpatient education increasesparental knowledge, whether knowledgeaffects behavior and outcomes, and themost effective mechanism for deliveringanticipatory guidance. Reich et al11 assessedwhether embedding pediatric anticipatoryguidance into books read to infants was aneffective way to educate low-income, first-time mothers about injury-prevention andhealth-promotion practices. The authorsconcluded that books read by mothers toinfants seemed to be an effective way toprovide anticipatory guidance. However, theystated that future work is needed todetermine if increased knowledge translatesinto safer and more developmentallyappropriate parenting practices.11 Usingvideo-based interventions, Paradis andcolleagues12 studied the effects of differentmedia forms on neonatal anticipatoryguidance. The authors found that media-based learning in the primary care office isfeasible and well accepted, and can have apositive impact on its target audience.Parents receiving the video interventionrated higher confidence with specific infantcare skills and reported feeling betterprepared to care for their infant comparedwith parents in the control group whoreceived anticipatory guidance via standardmethods.12 Videos, mobile phoneapplications, Web sites, and other venuesshould be explored as options for providinganticipatory guidance to families.

In conclusion, postpartum mothersappeared to have a high preexisting

FIGURE 2 Survey responses. All mothers, n 5 131; primiparous mothers, n 5 55; and multiparous mothers, n 5 76.

TABLE 1 Demographics of NewbornMothers Delivering at Universityof Michigan C.S. Mott Children’sHospital (April 2013–April 2014)

Characteristics n 5 3478, %

Marital status

Married 64.30

Single 32.80

Unknown or no answer 0.80

Significant other 0.70

Divorced 0.50

Legally separated 0.50

Widow 0.20

Age group, y

15–20 3.00

20–25 15.40

25–30 31.30

30–35 32.80

35–40 14.50

40–45 3.20

45–47 0.30

Race

White/Caucasian 70.10

Black/African American 13.60

Asian 9.00

Other or no answer 5.50

Unknown 1.40

American Indian and AlaskanNative

0.20

Native Hawaiian and OtherPacific Islanders

0.20

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knowledge of routine newborn care inour study. As mentioned previously,future studies are warranted to bestdetermine how and when to providenewborn parental education.

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9. Eisenberg L. Pioneers and modern ideas.Time is the currency of pediatric care.Pediatrics. 1998;102(1 pt 3 suppl 2):278–280

10. Hodax JK, Koster MP. An ounce ofanticipatory guidance is worth a poundof testing. Hosp Pediatr. 2015;5(8):456–458

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DOI: 10.1542/hpeds.2015-0197 originally published online January 1, 2016; 2016;6;310Hospital Pediatrics 

Kerry P. MychaliskaAlanna Staiman, Brendan D. Crawford, Kyle K. McLain, Theresa B. Gattari and

Evaluating Educational Needs of Parents at Newborn Discharge: A Pilot Study

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Kerry P. MychaliskaAlanna Staiman, Brendan D. Crawford, Kyle K. McLain, Theresa B. Gattari and

Evaluating Educational Needs of Parents at Newborn Discharge: A Pilot Study

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