248 - Clinician perspectives on acceptability, feasibility, and safety of maternal postpartum hypertension screening in newborn visit

Publication Number: 248.4296

Noah D. Buboltz, St. Christopher's Hospital for Children, Philadelphia, PA, United States; Mario DeMarco, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Adi Hirshberg, Perelman School of Medicine at the University of Pennsylvania, PHILADELPHIA, PA, United States; Rebecca Clark, University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Hadassah Colbert, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Peter Cronholm, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Emily Gregory, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Hypertension is a major cause of maternal morbidity and mortality and peaks in the week after birth, when birthing people typically attend newborn visits.

Objective: Develop an algorithm for acceptable, safe, and feasible postpartum hypertension screening in newborn care settings in Philadelphia, which has rates of maternal morbidity and mortality higher than national averages.

Design/Methods: We convened an interdisciplinary group (Obstetrics, Pediatrics, Family Medicine, Public Health Department) to develop an algorithm (Fig 1) and a survey on algorithm safety, feasibility, and acceptability. The collaboratively generated a recruitment list of clinicians involved in postpartum or newborn care. A survey link was emailed to 61 individuals at 5 institutions (the link allowed for forwarding) and was posted during a presentation to a Family Medicine practice collaborative focused on interconception care. The survey was piloted with 4 individuals in 7/2024 and fielded 8/2024 - 10/2024.

Results: 40 responses included data on clinical credentials. This included 18 Pediatrics (10 physicians, 2 NPs, 6 RNs), 9 Family Medicine (all physicians) and 13 Obstetrical clinicians (11 physicians, 2 CNM). 37 (93%) respondents worked at hospital-owned practices, and respondents predominantly served Medicaid insured patients (median 70% Medicaid insured). 25 (63%) held leadership or quality and safety positions. Respondents broadly agreed that postpartum blood pressure checks at newborn visits are appropriate (Table 1). Among pediatric clinicians (N=27), there was high endorsement of having equipment and staff to check postpartum blood pressure, and lower endorsement of having time to discuss and follow-up blood pressure results. When asked to assess feasibility of 4 potential strategies to check postpartum blood pressure during newborn visits (MA or RN checks, physician or NP checks, parent checks own BP on public device, and parent checks own BP on own device), the MA or RN check received the highest endorsement with 25 respondents endorsing this option as potentially feasible. In free text responses, pediatric clinicians raised concerns about adequate time and profession and legal responsibility for managing results. Obstetric clinicians broadly agreed the algorithm was safe but raised concerns about specific thresholds and the ability of pediatric teams to reach obstetric offices to ensure follow-up.

Conclusion(s): Postpartum hypertension screening during newborn visits was perceived as safe and acceptable. Concerns about feasibility reflect prior literature on introducing new screening topics into pediatric well visits.

Figure 1: Post-Partum Hypertension Protocol
htn_protocol_20240628_irb.pdfThis algorithm was developed to elicit feedback and promote innovation. The algorithm requires local evaluation and adaptation before adoption at any given site.

Table 1: Survey Results
htn_pas_20241031 - Table 1.pdf