Improving Patient Portal Activation for Newborns in the Well Baby Nursery.

BACKGROUND: Patient portals provide parents access to their child's health information and direct communication with providers. Our study aimed to improve portal activation rates of newborns during nursery hospitalization to >70% over 6 months. Secondarily, we describe the facilitators and barriers to portal use. METHODS: The study design used a mixed-methodology framework of quality improvement (QI) and cross-sectional analyses. The Model for Improvement guided QI efforts. The primary outcome was the proportion of portals activated for newborns during nursery hospitalization. Interventions included portal activation algorithm, staff huddles, and documentation templates. Telephone interviews were conducted with a randomized sample of mothers of infants who activated the portal. These mothers were divided into portal "users" and "nonusers." We examined sociodemographic variables and health care utilization outcomes in the 2 groups. RESULTS: Portal activation increased from 12.9% to 85.4% after interventions. Among 482 mothers with active portals, 127 (26.3%) were interviewed. Of those, 70% (89 of 127) reported using the portal, and 85.4% (76 of 89) found it useful. Reasons for accessing the portal included checking appointments and reviewing test results. Lack of knowledge of portal functionality was the main barrier to portal use (42.1%). Portal users were less likely to have a no-show to primary care appointments compared with nonusers (44.9% versus 78.9%, P < .001). CONCLUSIONS: Portal activation rates increased after QI interventions in the nursery. Most parents accessed the portal and found it useful. Portals can improve health care delivery and patient engagement in the newborn period.

Prenatal and Peripartum Exposure to Antibiotics and Cesarean Section Delivery Are Associated with Differences in Diversity and Composition of the Infant Meconium Microbiome.

The meconium microbiome may provide insight into intrauterine and peripartum exposures and the very earliest intestinal pioneering microbes. Prenatal antibiotics have been associated with later obesity in children, which is thought to be driven by microbiome dependent mechanisms. However, there is little data regarding associations of prenatal or peripartum antibiotic exposure, with or without cesarean section (CS), with the features of the meconium microbiome. In this study, 16S ribosomal RNA gene sequencing was performed on bacterial DNA of meconium samples from 105 infants in a birth cohort study. After multivariable adjustment, delivery mode (p = 0.044), prenatal antibiotic use (p = 0.005) and peripartum antibiotic use (p < 0.001) were associated with beta diversity of the infant meconium microbiome. CS (vs. vaginal delivery) and peripartum antibiotics were also associated with greater alpha diversity of the meconium microbiome (Shannon and Simpson, p < 0.05). Meconium from infants born by CS (vs. vaginal delivery) had lower relative abundance of the genus Escherichia (p < 0.001). Prenatal antibiotic use and peripartum antibiotic use (both in the overall analytic sample and when restricting to vaginally delivered infants) were associated with differential abundance of several bacterial taxa in the meconium. Bacterial taxa in the meconium microbiome were also differentially associated with infant excess weight at 12 months of age, however, sample size was limited for this comparison. In conclusion, prenatal and peripartum antibiotic use along with CS delivery were associated with differences in the diversity and composition of the meconium microbiome. Whether or not these differences in the meconium microbiome portend risk for long-term health outcomes warrants further exploration.