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Published on: December 31, 2015
Hospitalization Rates for Phototherapy in Neonates With Transcutaneous Bilirubin (TcB) Values >5.5 mg/dL Below the
Saman Aryal1, Olufunto Shonibare1, Sheng-Hsin Chen1
1Department of Pediatrics, New York City Health and Hospitals Corporation/Woodhull Medical Center, New York, USA.
Insights
Neonatal jaundice management: Infants discharged within 5.5 mg/dL of the phototherapy threshold face higher readmission risks. Maintaining a larger discharge margin and targeted follow-up can reduce hospitalizations.
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.
Introduction:
Neonatal jaundice (hyperbilirubinemia) affects over half of term infants. Although most cases are benign, some progress to severe hyperbilirubinemia, causing acute bilirubin encephalopathy or kernicterus. Early detection is essential. Total serum bilirubin (TSB) is the diagnostic standard, but invasive. Transcutaneous bilirubin (TcB) provides a reliable non-invasive screening tool. The 2022 American Academy of Pediatrics (AAP) guidelines define phototherapy thresholds but do not specify safe discharge bilirubin margins. Understanding outcomes for infants discharged near, but below, these thresholds may help guide follow-up and reduce readmissions.
Objective:
To evaluate hospitalization rates for phototherapy among neonates discharged with TcB values >5.5 mg/dL versus ≤5.5 mg/dL below the AAP phototherapy threshold and assess associations with ethnicity and feeding type.
Design/Methods:
A retrospective cohort study of 1,848 term and near-term infants discharged from a single birth center (September 2022-September 2024) was conducted. The difference between TcB and the AAP phototherapy threshold was calculated, and infants were categorized as >5.5 mg/dL or ≤5.5 mg/dL below the threshold. The primary outcome was rehospitalization for phototherapy within one week. Analyses included chi-square and t-tests.
Results:
Among 1,848 infants, 46 (2.5%) were rehospitalized for phototherapy. Rehospitalization occurred in 7.9% of infants discharged ≤5.5 mg/dL below threshold compared with 1.2% of those >5.5 mg/dL below (χ²=53.0, p<0.001). Infants discharged closer to the threshold were nearly seven times more likely to be readmitted. Asian and Hispanic infants had higher bilirubin levels and readmission rates (p<0.05). Exclusive breastfeeding showed a trend toward higher rehospitalization rates (3.3%) than formula (1.4%) or mixed feeding (1.6%) (p=0.061).
Conclusion:
Infants discharged within 5.5 mg/dL of the phototherapy threshold have a significantly higher risk of rehospitalization for phototherapy. Ethnicity and feeding type may influence risk. Maintaining a discharge margin >5.5 mg/dL and ensuring closer follow-up for higher-risk groups may reduce preventable readmissions and improve management of neonatal jaundice.
