Hospitalization Rates for Phototherapy in Neonates With Transcutaneous Bilirubin (TcB) Values >5.5 mg/dL Below the...

Area of Science:

• Neonatology
• Pediatrics
• Public Health

Background:

• Neonatal jaundice (hyperbilirubinemia) is common, but severe cases can cause brain damage.
• Total serum bilirubin (TSB) is standard but invasive; transcutaneous bilirubin (TcB) is a non-invasive screening tool.
• Current guidelines lack specific safe discharge bilirubin levels, impacting readmission rates.

Purpose of the Study:

• To assess rehospitalization rates for phototherapy in neonates discharged near American Academy of Pediatrics (AAP) phototherapy thresholds.
• To investigate if discharge TcB levels >5.5 mg/dL versus ≤5.5 mg/dL below the AAP threshold impact readmission.
• To examine associations between readmission risk, infant ethnicity, and feeding type.

Main Methods:

• Retrospective cohort study of 1,848 term and near-term infants (September 2022-September 2024).
• Infants categorized by TcB level relative to the AAP phototherapy threshold (≤5.5 mg/dL vs. >5.5 mg/dL below).
• Primary outcome: rehospitalization for phototherapy within one week of discharge; analyzed using chi-square and t-tests.

Main Results:

• Overall, 2.5% of infants were rehospitalized for phototherapy.
• Infants discharged ≤5.5 mg/dL below the threshold had a 7.9% readmission rate versus 1.2% for those >5.5 mg/dL below (p<0.001).
• Asian and Hispanic infants showed higher bilirubin levels and readmission rates; exclusive breastfeeding trended towards higher readmissions (p=0.061).

Conclusions:

• Discharging infants within 5.5 mg/dL of the phototherapy threshold significantly increases readmission risk.
• Infant ethnicity and feeding type appear to influence jaundice management outcomes.
• A discharge margin >5.5 mg/dL and focused follow-up for at-risk groups can decrease preventable neonatal jaundice readmissions.