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Readmission to Birth Hospital vs Nonbirth Hospital

Jeffery S. Garland, MD, SM; Colleen Alex, RN; John S. R. Deacon, MD; Karlo Raab, MD

Arch Pediatr Adolesc Med. 1994;148(12):1317-1321.

Abstract
Background/Objective
Indirect hyperbilirubinemia is a common cause for readmission to a hospital during the first week of life. Many newborn nurseries are ill equipped to readmit such newborns. The purpose of this study was to compare the care and treatment of infants with indirect hyperbilirubinemia who were readmitted to their birth hospital with those who were admitted to a hospital that differed from their birth hospital.

Design
Retrospective cohort study.

Setting
Children's and community hospitals.

Patients
We reviewed the records of 100 newborns who were readmitted during the first week of life (36 were readmitted to their birth hospital) with a primary admission diagnosis of indirect hyperbilirubinemia.

Results
Infants who were admitted to their birth hospital were less likely to have blood cultures (none of 36 vs 17 of 64, P=.0005), urine cultures (none of 36 vs eight of 64, P=.02), or more than one complete blood cell count (two of 36 vs 18 of 64, P=.001) performed compared with infants who were admitted to a nonbirth hospital. Antibiotic, intravenous therapy (P=.0005), and emergency department (P=.0001) use was more common among infants who were admitted to a nonbirth hospital. Infants who were admitted through the emergency department at a nonbirth hospital had phototherapy started later (mean±SD, 5.3±1.6 vs 2.2±1.7 hours; P=.0001) than did infants who were directly readmitted to the same nonbirth hospital.

Conclusions
Readmitting infants with indirect hyperbilirubinemia to birth hospitals or ensuring that accurate, timely, and complete information is obtained from the birth centers by admitting hospital personnel before laboratory studies and treatment are performed will reduce diagnostic workups and should reduce hospital charges for these infants. Phototherapy should be initiated in the emergency department if stabilization is required before admission.

(Arch Pediatr Adolesc Med. 1994;148:1317-1321)

Author Affiliations
From the Departments of Pediatrics (Drs Garland, Deacon, and Raab) and Nursing (Ms Alex), St Joseph's Hospital, and the Departments of Pediatrics, Children's Hospital of Wisconsin (Drs Garland, Deacon, and Raab) and St Mary's Hospital (Drs Garland, Deacon, and Raab), Milwaukee, Wis.

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