Phototherapy for Neonatal Unconjugated Hyperbilirubinemia: Examining Outcomes by Level of Care

Abstract

A B S T R A C TOBJECTIVES: Newborns hospitalized with unconjugated hyperbilirubinemia without critical comorbidities may receive intensive phototherapy (IP) in non-ICU levels of care, such as a mother-newborn unit, or ICU levels of care. Our aim was to compare outcomes between each level. METHODS:Using hospital discharge data from 2005 to 2011 in New York's State Inpatient Database, we performed multivariate analyses to compare outcomes that included total cost of hospitalization, length of stay, 30-day readmission rate after IP, and the number of cases of death, exchange transfusion, and g globulin infusion. We included term newborns treated with IP in their first 30 days of life and without diagnosis codes for other critical illnesses. Explanatory variables included level of care, sex, race, insurance type, presence or absence of hemolysis, hospital, volume of IP performed at each hospital, and year of hospitalization.

Risk factors associated with 31-day unplanned hospital readmission in newborns: a systematic review

“…Nine studies [ 3 , 7 , 19 , 23 , 28 , 30 , 32 , 38 , 39 ] identified the primiparous mother as a significant risk factor for readmission for newborns with an odds ratio (OR) ranging from 1.1 to 5.5. Maternal race/ethnicity was cited in eight differing studies [ 7 , 19 , 28 , 30 , 32 , 38 – 40 ]. Compared with other race/ethnicities, newborns of Asian mothers were more likely to be readmitted following the initial hospitalization at the time of birth (OR = 1.08 to 3.17).…”

“…In five studies, health care utilization and family resources, including uninsured health care status, unstable family income and inadequate support for the mother following the discharge, were identified as increasing the risk of newborn readmission [ 3 , 21 , 31 , 39 , 40 ]. Other studies differed, citing mothers who received comprehensive perinatal care as more likely to experience a UHR of their newborn [ 33 , 39 ].…”

“…The geographic location of both the hospital where the birth occurred and the residential address of parents was cited as risk factors by five differing studies [ 17 , 23 , 36 , 40 , 41 ]. Higher readmission rates were noted for births in non-metropolitan hospitals [ 22 , 36 ].…”

“…Newborns who either had a medical condition at birth or developed medical conditions following their birth were associated with an increased risk of UHRs [ 2 , 19 , 20 , 26 – 28 , 30 , 31 , 33 , 36 , 40 ]. Medical conditions included jaundice, haemolysis, congenital abnormalities, complex/chronic conditions, sepsis, seizure, cardiac surgery, and myelomeningocele repair of newborns.…”

“…Gender was examined and reported consistently across seven differing studies. Compared to females, male newborns experienced a higher risk of unplanned readmission after birth [ 7 , 23 , 32 , 36 , 38 – 40 ].…”