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Early Newborn Hospital Discharge and Readmission for Mild and Severe Jaundice
Jacqueline Grupp-Phelan, MD, MPH;
James A. Taylor, MD;
Lenna L. Liu, MD, MPH;
Robert L. Davis, MD, MPH
Arch Pediatr Adolesc Med. 1999;153:1283-1288.
Objectives To further explore the relationship of early newborn hospital discharge and readmission for jaundice, and to determine if early hospital discharge was associated with increased severity of jaundice among those readmitted.
Methods We performed a population-based case-control study using Washington State vital statistics, birth certificates, and hospital discharge abstracts from 1991 to 1995. Cases included 750 infants readmitted to the hospital for jaundice in the first 2 weeks of life; controls included 3192 infants not readmitted. Infants with severe medical conditions and those delivered by cesarean section were excluded. Early hospital discharge was defined as fewer than 30 hours in the hospital; late hospital discharge, 30 to 78 hours. We assessed the risk for hospital readmission for jaundice, for hospital readmissions classified as brief ( 2 days) or prolonged (>2 days), and for hospital readmissions classified as uncomplicated or complicated.
Results Infants discharged from the hospital early were at increased risk for jaundice (odds ratio, 1.34 [95% confidence interval, 1.10-1.64] adjusted for birth year, gestational age, maternal race and age, parity, payer, and infant sex). The risk associated with early hospital discharge was similar regardless of whether the hospital readmission was brief or prolonged and complicated or uncomplicated. One hundred twenty-two infants would have to stay for longer than 30 hours to avoid 1 jaundice readmission.
Conclusions While newborns discharged from the hospital early are at increased risk for hospital readmission for jaundice, the clinical significance is limited. Mandating longer neonatal stays may not be the most effective strategy to prevent hospital readmission for jaundice and its complications.
From the Department of Pediatrics, School of Medicine (Drs Grupp-Phelan, Taylor, Liu, and Davis), and the Department of Epidemiology, School of Public Health and Community Medicine (Dr Davis), University of Washington, Seattle. Dr Grupp-Phelan is now with the Division of Emergency Medicine, Children's Hospital Medical Center, Cincinnati, Ohio.
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