Early Newborn Discharge and Readmission for Mild and Severe Jaundice

1
Early Newborn Discharge and Readmission for Mild
and Severe Jaundice
For more information, contact Jacqueline
Grupp-Phelan, Department of Pediatrics Box
356320 Seattle, WA 98195 Tel. [phone] E-mail
jgphelan_at_u.washington.edu
Poster No. 307
Jacqueline Grupp-Phelan, James A. Taylor, Lenna
L. Liu and Robert L. Davis University of
Washington, Seattle, Washington

• METHODS (cont)
• Cases 750 babies readmitted within 14 days for
  jaundice
• Controls 3942 babies not readmitted frequency
  matched on date of birth
• Early discharge lt30 hours
  post-partum
• Late discharge 30 - 72 hours
  post-partum

Abstract Objective A past study showed early
newborn discharge places neonates at risk for
readmission in the first 30 days of life. Because
a large number of these readmissions were for
jaundice, we sought to further explore the
relationship of early newborn discharge and
readmission for jaundice, and to see if early
discharge was associated with increased severity
of jaundice among those readmitted. Methods We
performed a population-based case-control study
using Washington State vital statistic, birth
certificate and hospital discharge abstracts from
1991-95. Cases were 750 infants readmitted for
jaundice in the two first weeks of life, controls
were 3,192 infants not readmitted. Infants with
severe medical conditions and those status post
cesarean section were excluded. Early discharge
was defined as less than 30 hours and late
discharge as 30 - 72 hours. We assessed the risk
for jaundice readmission and for readmissions
classified as brief (??2 days) or prolonged (?) 2
days and for readmissions classified as
uncomplicated or complicated. Logistic regression
was used to determine the association between
early discharge and readmission for
jaundice. Results Of 3,942 infants studied, 750
cases were readmitted for jaundice. Among cases,
503 infants (67) were readmitted after early
discharge, while among controls, 1910 (60) were
readmitted after early discharge (Odds Ratio
(OR) 1.34, 95CI 1.10, 1.64, adjusted for birth
year, gestational age, maternal race and age,
payer, and infant sex). Newborns discharged early
were as likely to have a brief readmission (OR
1.35 95 CI 1.12,1.63) verses a prolonged
readmission (OR 1.43 95 CI 1.01, 2.04). Newborns
discharged early were as likely to have a
non-complicated jaundice readmission (OR 1.23
95CI 0.93, 1.62) verses a complicated jaundice
readmission (OR 1.44 95CI 1.17,1.78).
Conclusions While newborns discharged early are
at increased risk for readmission for jaundice,
the clinical significance is limited. Mandating
longer neonatal stays may not be the most
effective strategy to prevent readmission for
jaundice and its complications.
RESULTS (cont)

• Risk for readmission for jaundice after early
  discharge
• Newborn Stay (Hours) Readmitted
  Not Readmitted
• Early (lt30) 503
  1910
• Late (30-40) 247
  1282
• OR1.34 95 CI 1.10-1.64 (adjusted for year of
  birth, type of payer, infant gender, maternal
  age, gestational age, and parity.)
• Subset Analyses
• A trend toward increased risk for readmission for
  young maternal age (p 0.11)
• Less than 17 years OR 2.50 95 CI
  1.00,6.41
• Older mothers OR1.32 95 CI
  1.11,1.58
• No increased risk of readmission for the
  following maternal characteristics
• primip vs. multip OR1.29 (1.0,1.7) vs.
  1.51 (1.2,1.9)
• unmarried vs. married OR1.39 (0.9,2.0) vs.
  1.37 (1.1,1.6)
• There was no clear difference in risk for
  readmission after early discharge for infants
  discharged over a weekend vs. early in the week.
• Thurs-Sat OR1.43 95 CI 1.11,1.85
• Sun-Wed OR1.31 95 CI 1.04,1.66
• Length of Stay and Complications

• Jaundice Complication Variable
• kernciterus exchange transfusion
• sepsis death
• Analysis
• Unadjusted odds ratios calculated for
• risk for readmissions classified as brief
  (??2 days) vs. prolonged (?) 2 days
• uncomplicated vs. complicated
  readmission
• Logistic regression used to determine the
  association between early discharge and
  readmission for jaundice.

• Objectives
• To determine if early neonatal discharge is a
  risk factor for readmission for jaundice
• To determine if certain subgroups are at
  increased risk
• To determine if early neonatal discharge
  increases severity of jaundice
• Limitations
• Exact time of discharge is not available
• Breastfeeding and follow up information is not
  available
• Laboratory tests not accessible
• Conclusions
• Newborns discharged early are at increased risk
  for readmission for jaundice
• The clinical significance is limited
• Implications
• Mandating longer neonatal stays may not be the
  most effective strategy to prevent readmission
  for jaundice
• METHODS
• Population based case control study
• Data sources Washington State Birth Events
  Record Database linked to Hospital Discharge
  Abstracts

RESULTS