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Variation in Care and Clinical Outcomes Among Infants Hospitalized With Hyperbilirubinemia

Adrienne G DePorre1,2, Matthew Hall3,2,4, Henry T Puls3,2

  • 1Division of Hospital Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; adeporre@cmh.edu.

Hospital Pediatrics
|September 12, 2020
PubMed

Insights

Hospital practices for neonatal hyperbilirubinemia vary significantly. Additional lab tests, beyond bilirubin levels, may increase resource use without improving outcomes like readmissions.

Area of Science:

  • Neonatal Medicine
  • Pediatric Healthcare Quality
  • Health Services Research

Background:

  • Neonatal hyperbilirubinemia is a common condition requiring hospitalization.
  • Variations in clinical practice can impact healthcare resource utilization and patient outcomes.
  • Understanding hospital-level practice patterns is crucial for optimizing care.

Purpose of the Study:

  • To assess hospital variations in laboratory testing and intravenous fluid (IVF) use for infants with neonatal hyperbilirubinemia.
  • To examine the association between these interventions and hospitalization outcomes.

Main Methods:

  • Retrospective multicenter study of infants (2-7 days old) hospitalized with hyperbilirubinemia (Dec 2016-Jun 2018).
  • Data sourced from the Pediatric Health Information System.
  • Hospital-level variations adjusted for clinical/demographic factors; associations with outcomes analyzed using Pearson correlation.

Main Results:

  • 4396 infants identified. Frequent tests included direct antiglobulin testing, reticulocyte count, CBC, ABO blood type, and electrolytes.
  • Significant hospital variation in laboratory testing and IVF administration (P < .001).
  • Increased laboratory testing associated with longer length of stay (P = .007); IVF use was not (P = .162). Neither impacted readmissions or ED revisits.

Conclusions:

  • Substantial hospital-level variation exists in managing neonatal hyperbilirubinemia.
  • Additional laboratory testing beyond bilirubin measurement may increase resource use without clear benefit.
  • Further research into standardized care pathways may be warranted.
Abstract

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