Please select the eligibility criteria that correspond to the clinical trial below.
Title: Improving Health Outcomes for New Mothers and Babies
Brief Summary: Because adherence to postnatal care guidelines across the United States (U.S.) is poor, newborns and mothers often are placed at undue risk for adverse medical and social outcomes. This study aims to evaluate an alternative model of care and improve healthcare delivery to and reduce health disparities for "well" newborns and mothers after hospital discharge by using single postnatal home nurse visits. The principal investigator has previously shown a reduction in poor outcomes for infants who receive a home visit after discharge when studied retrospectively. The proposed research will build on the previous study and prospectively evaluate the impact of a single home nursing visit on morbidities and health disparities for newborns and mothers in a randomized, controlled trial involving 1154 mother/infant breastfeeding dyads. Home visits should guarantee detailed assessment during an at-risk period of infancy and motherhood, where medical and social problems can be recognized, anticipated, and/or treated, and can bridge the gap between hospital care and primary care. The investigators' program, The Nurses for Infants Through Teaching and Assessment after the NurserY (NITTANY) Initiative, also will consider the cost-effectiveness of home visitation compared with guidelines-adherent outpatient clinic care.


Options:
A: Inclusion Criteria:

* Mothers of infants admitted during the study period with hyperbilirubinemia, breastfeeding at the time of admission (any amount of breastfeeding)
* Mothers of infants \< 1 month of age at the time of admission

Exclusion Criteria:

* Mothers of infants admitted with hyperbilirubinemia who are exclusively formula-fed
* Mothers of infants with hyperbilirubinemia of the predominantly conjugated type as this is a different disease, not associated with breastfeeding difficulties
* Mothers of infants with anatomical abnormalities, such as cleft lip or palate, as this would interfere with breastfeeding and require more intensive intervention.
* Mothers of neurologically impaired infants as breastfeeding may be more difficult in this population
* Mother of infants who were admitted to the Neonatal Intensive Care Unit (NICU) after birth and never went home as they are likely to have other comorbidities affecting feeding.
* Mothers of infants feeding via naso-gastric, naso-jejunal, or gastric tube
* Mothers of infants \> 1 month of age
* Mothers who have had breast surgery in the past
* Foster mothers or adoptive mothers
* Mothers who do not understand English or French
* Mothers of infants that are the result of multiple birth (eg twins)
B: Inclusion Criteria:

* First time mother
* Mother 18 years old or older
* 37 weeks gestation or greater at delivery
* Intent to breastfeed

Exclusion Criteria:

* mother's primary language is something other than English or Spanish
* mother has medical complications that interfere with her instituting breastfeeding or require her to stay in the hospital for \>72 hours
* infant has a medical problem that requires admission to the intensive care nursery or requires hospitalization for \>72 hours
* mother expresses a strong desire to formula feed
C: Inclusion Criteria:

* Full term or late pre-term infant (\> 34 0/7 weeks gestational age) discharged from the newborn nursery
* Feeding human milk (breast milk) during the maternity/newborn stay with intent to continue to breastfeed after discharge
* English speaking mother
* Singleton or twin infant

Exclusion Criteria:

* Premature infant \< 34 weeks gestational age
* Exclusively formula fed infant during nursery stay
* Complicated maternity/nursery stay requiring \> 2 night stay after a vaginal delivery or \> 4 night stay after a cesarean section
* A nursery course with atypical complications (e.g. a work-up for ambiguous genitalia)
* Infant with hyperbilirubinemia requiring phototherapy during the nursery stay
* Any major maternal morbidities and/or pre-existing condition that would effect postpartum care such as cancer, multiple sclerosis, lupus, etc.
* Previous maternal participation in the NITTANY trial
* Residence outside of the coverage area for the Visiting Nurses Association (VNA) of Central Pennsylvania
* Family with no active telephone number (home or cellular)
* Infant being put up for adoption
* Non-English speaking mother
* Family requiring a home visit due to Social Work or other staff request/order
* Triplets or higher order gestation
D: Inclusion Criteria:

* Birth at one of 34 Maternity Hospitals in Republic of Belarus
* Breastfeeding initiated at birth, with no contraindications to breastfeeding
* Apgar score \>=5 at 5 minutes
* Full term gestation
* Birth weight \> 2500g

Answer: C