Length of Stay, Jaundice, and Hospital Readmission

Maisels, M. Jeffrey; Kring, Elizabeth

doi:10.1542/peds.101.6.995

Cited by 283 publications

(227 citation statements)

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“…J aundice is an important problem during neonatal period, especially in the fi rst week of life 1 . The serum bilirubin level varies with birth weight, gesta onal age, chronological age and internal milieu of the body.…”

Section: Introductionmentioning

confidence: 99%

Adverse Events of Exchange Transfusion in Neonatal Hyperbilirubinemia

Chitlangia

Shah

Poudel

et al. 2014

J. Nepal Paedtr. Soc.

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Introduction: Jaundice is an important problem during neonatal period. When total serum bilirubin (TSB) level exceeds a critical limit, it crosses the blood brain barrier and results into bilirubin encephalopathy. The main aim of therapy for neonatal hyperbilirubinemia is prevention of bilirubin encephalopathy by phototherapy and/or exchange transfusion. The aims of this study were to evaluate the efficacy of exchange transfusion (ET) and observe the adverse events during and following three days of ET in neonates with hyperbilirubinemia. Materials and Method: Hospital based cross-sectional descriptive study. All neonates admitted to neonatal intensive care unit and /or paediatric wards of a tertiary-care centre between September 2010 to March 2012, requiring ET were enrolled. Results: A total of 139 ETs were performed in 120 neonates. The common causes were ABO incompatibility (30.8%), prematurity (30.8%), idiopathic (27.5%), Rh isoimmunization (6.7%) and cephalhematoma (4.2%). Mean pre-ET total serum bilirubin (TSB) was 24.2 mg% dL. There was 58% reduction in TSB in post ET and 31% net reduction in 6 hr post ET. Term and preterm neonates showed equal percentage of TSB reduction. Respiratory distress (10.8%) and bradycardia (6.7%) were the common adverse events during, and hypocalcemia (98.3%) and thrombocytopenia (34.2%) in 3 days following ET. The sick neonates had significantly higher incidence of thrombocytopenia (p= 0.031), respiratory distress (p=0.009), apnea (p<0.001) and cardiorespiratory arrest (p<0.001). Overall mortality was 4.2%, and non-survivors were mostly low birth weight, born outside the present hospital and had higher incidence of adverse events. Conclusion: Exchange transfusion is an effective intervention in reducing the serum bilirubin level. However, these neonates require monitoring of ionised calcium and thrombocytopenia. Sick neonates had higher incidence of adverse events than healthy and close clinical monitoring is needed to improve the outcome.

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Section: Introductionmentioning

confidence: 99%

Adverse Events of Exchange Transfusion in Neonatal Hyperbilirubinemia

Chitlangia

Shah

Poudel

et al. 2014

J. Nepal Paedtr. Soc.

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“…Case control studies have also shown inconsistent results. [8][9][10] Studies have also found that infants born at 37 to 38 weeks' gestational age were at increased risk for developing hyperbilirubinemia 11,12 and were more likely to be readmitted to hospital for jaundice compared with infants born at .40 weeks' gestational age; 10 however, the impact of early discharge on this group of infants has not been assessed.To date there has been no populationbased study investigating early discharge and readmission for jaundice that comprehensively adjusts for known major risk factors for jaundice, such as gestational age, breastfeeding, and Asian race, 2 and risk factors for readmission to hospital, including maternal age, birth order, and maternal smoking. 13 The aims of this study are to (1) examine the association between early discharge from hospital after birth, week of gestational age, and readmission to hospital for jaundice among term infants; and (2) investigate the perinatal risk factors for readmission to hospital for jaundice among infants discharged early.…”

mentioning

confidence: 99%

Early Discharge of Infants and Risk of Readmission for Jaundice

et al. 2015

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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...

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“…This approximately twofold greater prevalence of kernicteric males is also evident in the late preterm subgroup in the registry [4]. Previous observations demonstrated that males have higher bilirubin levels than females [2,49,50], and not surprisingly, they are over represented in that cohort of infants readmitted to the hospital for evaluation and management of neonatal jaundice, with an odds ratio of 2.89 (confidence interval [CI] 1.46 to 5.74) as compared with their female counterparts [2]. Taken together, these findings suggest an increased risk for marked jaundice and an increased susceptibility to bilirubin-induced injury in male neonates.…”

Section: Male Sex and Riskmentioning

confidence: 53%

“…Hyperbilirubinemia is the most common clinical condition requiring evaluation and treatment in the newborn [1] and the most common cause for hospital readmission during the first week of postnatal life [2][3][4][5]. Although generally a benign transitional phenomenon of no overt clinical significance, in a select few, the total serum bilirubin (TSB) may rise to hazardous levels that pose a direct threat of brain damage.…”

mentioning

confidence: 99%

Hyperbilirubinemia and Bilirubin Toxicity in the Late Preterm Infant

Watchko

2006

Clinics in Perinatology

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Length of Stay, Jaundice, and Hospital Readmission

Cited by 283 publications

References 11 publications

Adverse Events of Exchange Transfusion in Neonatal Hyperbilirubinemia

Adverse Events of Exchange Transfusion in Neonatal Hyperbilirubinemia

Early Discharge of Infants and Risk of Readmission for Jaundice

Hyperbilirubinemia and Bilirubin Toxicity in the Late Preterm Infant

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