Length of Stay, Jaundice, and Hospital Readmission

Abstract

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.