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Length of stay, jaundice, and hospital readmission
1Department of Pediatrics, William Beaumont Hospital, Royal Oak, Michigan 48073-6769, USA.
Insights
Discharging infants before 72 hours of age increases hospital readmission risk, especially for hyperbilirubinemia. Effective breastfeeding support from birth can help reduce this risk for newborns.
Area of Science:
- Neonatal care
- Pediatric readmission risk
- Public health
Background:
- Postnatal discharge timing is a critical factor in infant health outcomes.
- Hyperbilirubinemia is a common reason for newborn readmission.
- Early discharge may increase the risk of adverse events.
Purpose of the Study:
- To assess the impact of postnatal discharge age on hospital readmission rates.
- To specifically examine the association between discharge timing and hyperbilirubinemia readmissions.
- To identify risk factors for infant readmission.
Main Methods:
- A case-control study utilizing chart reviews was conducted.
- Infants readmitted within 14 days of discharge were compared to a non-readmitted control group.
- Data were collected from a large suburban community hospital over a six-year period.
Main Results:
- Infants discharged before 72 hours had a significantly higher risk of readmission compared to those discharged later.
- Key risk factors for readmission included prematurity, jaundice in the nursery, male sex, and breastfeeding.
- Discharge before 48 hours did not confer a greater risk than discharge between 48 and 72 hours.
Conclusions:
- Discharging infants before 72 hours of age increases the risk of hospital readmission, particularly for hyperbilirubinemia.
- Current recommendations for follow-up care for early-discharged infants should be extended to those discharged before 72 hours.
- Enhanced breastfeeding support at birth is a potential strategy to mitigate readmission risks.
Objective:
To evaluate the effect of postnatal age at the time of discharge on the risk of readmission to hospital with specific reference to readmission for hyperbilirubinemia.
Design:
Case-control study based on chart review.
Setting:
Large suburban community hospital in southeastern Michigan, delivering more than 5000 infants annually.
Patients:
Newborn infants, born between December 1, 1988, and November 30, 1994, who were readmitted to hospital within 14 days of discharge, were compared with a randomly selected control group who were not readmitted.
Results:
Of 29,934 infants discharged, 247 (0.8%) were readmitted by the age of 14 days. One hundred twenty-seven (51%) were admitted because of hyperbilirubinemia and 74 (30%) with the diagnosis of "rule out sepsis." The factors associated with an increased risk of readmission to the hospital were: infant of diabetic mother [odds ratios (OR), 3.45; 95% confidence limits (CL), 1.39 to 8.60]; gestation < or = 36 weeks (OR, 4.56; CL, 1.45 to 14.33), and 37 1/7 to 38 weeks (OR, 2.95; CL, 1.63 to 5.35) versus > or = 40 weeks; presence of jaundice in the nursery (OR, 1.73; CL, 1.14 to 2.63); breastfeeding (OR, 1.78; CL, 1.13 to 2.81); male sex (OR, 1.58; CL, 1.07 to 2.34); length of stay < 48 hours (OR, 1.91; CL, 1.15 to 3.16) and 48 to < 72 hours (OR, 2.09; CL, 1.25 to 3.50) versus > or = 72 hours. Factors associated with readmission for jaundice were gestation < or = 36 weeks (OR, 13.2; CL, 2.70 to 64.6), 36 1/7 to 37 weeks (OR, 7.7; CL, 2.69 to 22.0), 37 1/7 to 38 weeks (OR, 7.2; CL, 3.05 to 16.97) versus > or = 40 weeks; jaundice during nursery stay (OR, 7.80; CL, 3.38 to 18.0); length of stay < 48 hours (OR, 2.40; CL, 1.09 to 5.30) and 48 to < 72 hours (OR, 3.15; CL, 1.40 to 7.09) versus > or = 72 hours; male sex (OR, 2.89; CL, 1.46 to 5.74); and breastfeeding (OR, 4.21; CL, 1.80 to 9.87). Infants whose length of stay was < 48 hours were at no greater risk for readmission for jaundice or other causes than those whose length of stay was > or = 48 hours to < 72 hours.
Conclusions:
Discharge at any time < 72 hours significantly increases the risk for readmission to hospital and the risk for readmission with hyperbilirubinemia when compared with discharge after 72 hours. The American Academy of Pediatrics recommends that infants discharged < 48 hours should be seen by a health care professional within 2 to 3 days of discharge. Our observations, as well as those of others, suggest that this recommendation should also be extended to those discharged at < 72 hours after birth. One approach to decreasing the risk of morbidity and readmission, particularly from hyperbilirubinemia, would be to help mothers to nurse their infants more effectively from the moment of birth.