Effect of Neonatal Jaundice and Phototherapy on the Frequency of First-Year Outpatient Visits

Abstract

Objective The objective of this study was to determine whether either hyperbilirubinemia or inpatient phototherapy is associated with increased subsequent outpatient visit rates, a possible effect of the “vulnerable child syndrome.” Methods We compared 3 groups of otherwise well term and late-preterm infants who were born between 1995 and 2004 in Northern California Kaiser hospitals: group 1 never had a documented total serum bilirubin (TSB) level ≥12 mg/dL (n = 128 417); group 2 had a TSB level ≥17 and <23 mg/dL as outpatients between 48 hours and 7 days of age and did not receive inpatient phototherapy (n = 6777); and group 3 met criteria for group 2 but did receive inpatient phototherapy (n = 1765). We compared outpatient visit rates from 15 to 364 days of age adjusting for other predictors of visit rates by using Poisson and linear regression. Results The mean total number of visits between 15 and 364 days was 9.83. Compared with group 1, adjusted total first-year visit rates were slightly increased in group 2 (adjusted incidence rate ratio: 1.04 [95% confidence interval: 1.02–1.05]) and group 3 (incidence rate ratio: 1.07 [95% confidence interval: 1.05–1.10]). The increases in visit rates were greatest for visits from 15 to 59 days of age, for specialty visits, and for unspecified diagnoses. These rates correspond to adjusted increases in total first-year visits (compared with group 1) of 0.36 visits in group 2 and 0.73 visits in group 3. Conclusions Neonatal jaundice and inpatient phototherapy are associated with only small increases in first-year outpatient visit rates, consistent with mild or infrequent contribution to the vulnerable child syndrome in this population.

Prevalence and burden of illness of treated hemolytic neonatal hyperbilirubinemia in a privately insured population in the United States

“…Approximately half (51%) of all readmissions occurring 2 weeks after birth were attributable to NHB [27]. The increase in physician office visits we reported was also consistent with available literature, which found that NHB was associated with increased parental awareness, and newborns receiving phototherapy had higher rates of outpatient visits [28].…”

Association Between Laboratory Calibration of a Serum Bilirubin Assay, Neonatal Bilirubin Levels, and Phototherapy Use

“…This can interfere with breastfeeding and bonding and cause parental anxiety. [15][16][17][18] Calibration shifts in laboratory assays can have major clinical implications. While theoretical models can predict these effects, it is rare to capture the consequential extent of the…”

Overdiagnosis: How Our Compulsion for Diagnosis May Be Harming Children

“…31 In another study, parents of children with feeding and crying problems in infancy necessitating a change in formula were more likely to perceive their child as vulnerable .3 years later, despite being no more likely to report allergies, asthma, or eczema for their child. 32 Finally, parents of infants with jaundice or phototherapy exposure are more likely to seek medical attention for their child well after jaundice resolution, 33 perceive subsequent illnesses as moderate or severe, and fear leaving their baby with any other caregiver. 34 Diagnoses also affect how children are treated by society.…”