University of California, San Francisco, California.
Penn State College of Medicine, Hershey, Pennsylvania.
Hosp Pediatr. 2022 Jun 1;12(6):e180-e184. doi: 10.1542/hpeds.2021-006470.
The Newborn Weight Tool (NEWT) can inform newborn feeding decisions and might reduce health care utilization by preventing excess weight loss. Clinical decision support (CDS) displaying NEWT might facilitate its use. Our study's objective is to determine the effect of CDS displaying NEWT on feeding and health care utilization.
At an hospital involved in NEWT development, we randomly assigned 2682 healthy infants born ≥36 weeks gestation in 2018-2019 either to CDS displaying NEWT with an electronic flag if most recent weight was ≥75th weight loss centile or to a control of usual care with NEWT accessed at clinician discretion. Our primary outcome was feeding type concordant with weight loss, defined as exclusive breastfeeding for those not flagged, exclusive breastfeeding or supplementation for those flagged once, and supplementation for those flagged more than once. Secondary outcomes included inpatient and outpatient utilization in the first 30 days. We used χ2 and Student's t tests to compare intervention infants with control and to compare trial infants with those born in 2017.
Feeding was concordant with for 1854 (74.5%) trial infants and did not differ between randomized groups (P = .65); concordant feeding was higher for all trial infants than for infants born in 2017 (64.4%; P < .0005). Readmission occurred for 51 (3.8%) CDS infants and 45 (3.4%) control infants (P = .56). Among the 60% of trial infants with outpatient records available, there were 3.5 ± 1.7 visits with no differences between randomized groups (P = .10).
At an hospital involved in NEWT development, CDS displaying NEWT did not alter either feeding or health care utilization compared with discretionary NEWT access.
新生儿体重工具（NEWT）可用于指导新生儿喂养决策，并可能通过防止体重过度减轻来减少医疗保健的利用。显示 NEWT 的临床决策支持（CDS）可能有助于其使用。我们的研究目的是确定显示 NEWT 的 CDS 对喂养和医疗保健利用的影响。
在一家参与 NEWT 开发的医院，我们于 2018-2019 年随机分配 2682 名≥36 周妊娠的健康婴儿，一组为 CDS 显示 NEWT，如果最近的体重≥第 75 个体重减轻百分位数，则会出现电子标志，如果体重没有减轻则显示电子标志，另一组为常规护理的对照组，NEWT 由临床医生酌情决定。我们的主要结局是与体重减轻一致的喂养类型，定义为未标记的婴儿纯母乳喂养，标记一次的婴儿纯母乳喂养或补充喂养，标记多次的婴儿补充喂养。次要结局包括出生后 30 天内的住院和门诊利用。我们使用 χ2 和 Student's t 检验比较干预组婴儿与对照组婴儿，比较试验组婴儿与 2017 年出生的婴儿。
1854 名（74.5%）试验组婴儿的喂养方式与体重减轻一致，随机分组之间没有差异（P =.65）；所有试验组婴儿的一致喂养率均高于 2017 年出生的婴儿（64.4%；P <.0005）。CDS 组有 51 名（3.8%）婴儿和对照组有 45 名（3.4%）婴儿再次入院（P =.56）。在可获得门诊记录的 60%的试验组婴儿中，有 3.5 ± 1.7 次就诊，随机分组之间没有差异（P =.10）。
在一家参与 NEWT 开发的医院，与酌情使用 NEWT 相比，显示 NEWT 的 CDS 并没有改变喂养或医疗保健的利用。
