Early Newborn Discharge and Readmission for Mild and Severe Jaundice

Jacqueline Grupp-Phelan, James A. Taylor, Lenna L. Liu and Robert L. DavisUniversity of Washington, Seattle, Washington

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, 95%CI 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 95%CI 0.93, 1.62) verses a complicated jaundice readmission (OR 1.44 95%CI 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.

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

Risk for readmission for jaundice after early discharge:

Newborn Stay (Hours) Readmitted Not

Readmitted

Early (<30) 503 1910

Late (30-40) 247 1282

OR=1.34 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 OR=1.32 95% CI 1.11,1.58

No increased risk of readmission for the following maternal characteristics:•primip vs. multip OR=1.29 (1.0,1.7) vs. 1.51 (1.2,1.9) •unmarried vs. married OR=1.39 (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 OR=1.43 95% CI 1.11,1.85 Sun-Wed OR=1.31 95% CI 1.04,1.66 Length of Stay and ComplicationsUpon readmission for jaundice, infants were at no greater risk for longer admissions:LOS 2 days OR=1.35 95% CI 1.12,1.63 LOS > 2 days OR=1.43 95% CI 1.01,2.04

Or for more severe complications:Non-severe admission OR=1.23 95% CI 0.93,1.62 Severe admission OR=1.44 95% CI 1.17,1.78

Number Needed to Treat Analysis385 infants would need to stay > 30 hours to avoid one readmission due to early discharge

RESULTS (con’t)

Poster No. 307

For more information, contact:Jacqueline Grupp-Phelan,Department of PediatricsBox 356320Seattle, WA 98195Tel. 206 543-3209E-mail jgphelan@u.washington.edu

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 accessibleConclusions•Newborns discharged early are at increased risk for readmission for jaundice•The clinical significance is limited ImplicationsMandating 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

Figure 1Early versus Late Discharge by Year

0

100

200

300

400

500

600

700

800

900

1991 1992 1993 1994 1995

Num

ber o

f Inf

ants

Late

Early

S tu d y P op u la tion

A fte r exc lu s ion s7 5 0 c as es

3 ,9 4 2 c on tro ls

J au n d ic e as on e o f th e firs t th ree d iag n os es4 ,0 9 9 c as es

R eam is s ion w ith in th e firs t tw o w eek s7 ,3 8 8 c as es

R ead m is s ion s4 2 ,2 7 4 in fan ts

To ta l B irth s3 4 8 ,4 9 5

RESULTS

Jaundice Complication Variable: kernciterus exchange transfusion sepsis deathAnalysis•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.