Early Discharge of Infants and Risk of Readmission for Jaundice

Abstract

OBJECTIVES: To examine the association between early discharge from hospital after birth and readmission to hospital for jaundice among term infants, and among infants discharged early, to investigate the perinatal risk factors for readmission for jaundice.METHODS: Birth data for 781 074 term live-born infants born in New South Wales, Australia from 2001 to 2010 were linked to hospital admission data. Logistic regression models were used to investigate the association between postnatal length of stay (LOS), gestational age (GA), and readmission for jaundice in the first 14 days of life. Other significant perinatal risk factors associated with readmission for jaundice were examined for infants discharged in the first 2 days after birth.RESULTS: Eight per 1000 term infants were readmitted for jaundice. Infants born at 37 weeks' GA with an LOS at birth of 0 to 2 days were over 9 times (adjusted odds ratio [aOR] 9.43; 95% CI, and at 38 weeks' GA were 4 times (aOR 4.05; 95% CI, 3.62-4.54) more likely to be readmitted for jaundice compared with infants born at 39 weeks' GA with an LOS of 3 to 4 days. Other significant risk factors for readmission for jaundice for infants discharged 0 to 2 days after birth included vaginal birth, born to mothers from an Asian country, born to first-time mothers, or being breastfed at discharge.CONCLUSIONS: This study can inform guidelines or policy about identifying infants at risk for readmission for jaundice and ensure that appropriate post-discharge follow-up is received.WHAT'S KNOWN ON THIS SUBJECT: Studies examining early postnatal discharge and readmission for jaundice report conflicting results. Infants born 37 to 38 weeks' gestation have an increased risk for readmission for jaundice; however, the impact of early discharge on this group has not been investigated. WHAT THIS STUDY ADDS:Early postnatal discharge was significantly associated with readmission for jaundice. Of the infants discharged early, those born 37 to 38 weeks' gestation, born via vaginal delivery, born to Asian mothers, or were breastfed had the greatest risk for readmission. Dr Lain participated in the study design, took primary responsibility of the data analysis, and drafted the initial manuscript; Associate Professor Roberts participated in the study design and data analysis and interpretation, and reviewed and revised manuscript; Dr Bowen participated in interpretation of the data and revision of manuscript for important clinical content; Associate Professor Nassar participated in the study design and data analysis and interpretation, and reviewed and revised manuscript; and all authors approved the final manuscript as submitted. The length of stay (LOS) in hospital after the birth of a child has been a controversial topic over the past few decades. A Cochrane Review found early postnatal discharge, defined as earlier than standard care, to have no adverse effects on breastfeeding and maternal depression when accompanied by a policy of nursing/midwifery home visits. However, they reported more re...

Hospital Admission and Emergency Department Utilization in an Infant Medicaid Population

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Umbilical Cord Bilirubin Levels as a Predictor of Subsequent Development of Clinically Significant Neonatal Hyperbilirubinemia

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