Readmission for Neonatal Jaundice in California, 1991–2000: Trends and Implications

Burgos, Anthony E.; Schmitt, Susan; Stevenson, David K.; Phibbs, Ciaran S.

doi:10.1542/peds.2007-1214

Cited by 85 publications

(74 citation statements)

References 23 publications

(15 reference statements)

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“…Since the readmission rate for jaundice treatment is generally <1% [9], it is not likely that with only 100 study subjects we would have had any readmissions and, indeed, we did not. However, our study tested a high-risk subset and therefore perhaps it is indeed relevant that none was readmitted for jaundice treatment.…”

Section: Discussionmentioning

confidence: 99%

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Measuring End-Tidal Carbon Monoxide of Jaundiced Neonates in the Birth Hospital to Identify Those with Hemolysis

Christensen¹,

Malleske²,

Lambert³

et al. 2015

Neonatology

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Background: End-tidal breath carbon monoxide (ETCOc) levels correlate with catabolism of heme, but until recently, this measurement was not readily available for application to neonatology practice. Objectives: We performed a prospective, multihospital, test-of-concept study where ETCOc was measured during the birth hospitalization of neonates with a total bilirubin (TB) value >75th percentile on the Bhutani bilirubin nomogram. This was done to test the feasibility and ease of use of this new device. Methods: Neonates with an elevated ETCOc (with a >95th percentile reference interval previously established) were labeled as having ‘hemolytic jaundice'. We recommended a follow-up TB check <24 h after hospital discharge to these families. Results: One hundred and fifteen neonates were eligible for the study, the parents of 103 provided consent, and measurements were obtained for 100. Sixty-three had normal and 37 had elevated ETCOc values. By means of a direct antiglobulin test (DAT; Coombs), 11 of these 37 were found positive for ABO hemolytic disease; the remaining 26 had other etiologies. Thirty-six of the 37 with an elevated ETCOc had repeat TB monitoring <24 h after discharge home. None of the 100 were rehospitalized for jaundice treatment compared with a rate of 2.99 rehospitalizations per 100 control neonates who had a TB value >75th percentile (p = 0.079). Conclusion: ETCOc measurement is a feasible means of assessing hemolysis in jaundiced neonates during the birth hospitalization. When hemolysis is identified, parents are likely to comply with instructions to bring the infant for a TB checkup <24 h after discharge home.

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Section: Discussionmentioning

confidence: 99%

“…We judged that the readmission rate would be too low (<10 readmissions/1,000 births [9]) for a meaningful comparison, given the sample size of 100. However, we considered the possibility that our study group would be made up of neonates more likely to be readmitted for jaundice treatment, because they all had TB levels >75th percentile.…”

Section: Methodsmentioning

confidence: 99%

Measuring End-Tidal Carbon Monoxide of Jaundiced Neonates in the Birth Hospital to Identify Those with Hemolysis

Christensen¹,

Malleske²,

Lambert³

et al. 2015

Neonatology

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“…Contudo, esperava-se que os RNs de 35 semanas apresentassem maior risco de reinternação, comparativamente aos de maior idade gestacional, como já sugerido anteriormente 12,24 . Pode-se supor que o número relativamente pequeno de RNs mais imaturos, nesta amostra, tenha impedido a expressão da menor idade gestacional como fator de risco.…”

Section: Discussionunclassified

Systematic follow-up of hyperbilirubinemia in neonates with a gestational age of 35 to 37 weeks

2011

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Objectives: To determine the outcomes of an intervention for follow-up of bilirubinemia in the first week of life in a cohort of newborn infants with gestational ages between 35 0/7 and 37 6/7 weeks and to determine risk factors for readmission for phototherapy (total bilirubin > 18 mg/dL). Methods:Retrospective cohort study carried out at a public teaching hospital. Neonates underwent periodic monitoring of total bilirubin levels (measured in plasma or by transcutaneous device) before and after discharge to assess the need for phototherapy. A systematic approach, based on risk percentiles of a bilirubin reference curve, was employed. Results:The study sample comprised 392 neonates. Only one outpatient visit was required in 61.7% of newborns. Peak total bilirubin was ≥ 20 mg/dL in 34 neonates (8.7%), and reached 25-30 mg/dL in three (0.8%). Phototherapy was indicated after discharge in 74 neonates (18.9%). Weight loss between birth and first follow-up visit and total bilirubin above the 40th percentile at discharge were risk factors for requiring phototherapy. Total bilirubin above the 95th percentile at discharge was associated with greater risk of readmission ). Weight loss between discharge and first follow-up visit was the sole independent clinical predictor (RR = 1.16 [1.04-1.17]). Conclusion:Systematic follow-up during the first week of life was effective in preventing dangerous hyperbilirubinemia. Encouraging breastfeeding and discharging neonates only after weight loss has been stabilized may prevent readmission due to hyperbilirubinemia.J Pediatr (Rio J). 2011;87(4):301-306: Hyperbilirubinemia, jaundice, premature infant, newborn infant. ResumoObjetivos: Identificar os resultados do acompanhamento da bilirrubinemia na primeira semana de vida em uma coorte de recém-nascidos (RNs) de 35 0/7 a 37 6/7 semanas de idade gestacional e estabelecer fatores de risco para reinternação para fototerapia pós-alta hospitalar (bilirrubinemia total > 18 mg/dL). Métodos:Estudo de coorte retrospectivo em hospital público universitário. Os recém-nascidos tiveram acompanhamento da bilirrubina total plasmática ou transcutânea pré-e pós-alta da enfermaria de alojamento conjunto para avaliação da necessidade de fototerapia. Foi empregada uma abordagem sistematizada, utilizando-se os percentis de risco de uma curva de referência. Conclusão:A abordagem sistematizada da bilirrubinemia na 1ª semana foi efetiva na prevenção de hiperbilirrubinemias perigosas. O suporte à amamentação e a alta hospitalar após a estabilização da perda de peso podem ser medidas preventivas da reinternação por hiperbilirrubinemia.J Pediatr (Rio J). 2011;87(4) IntroduçãoOs recém-nascidos (RNs) prematuros apresentam maior risco de reinternação por hiperbilirrubinemia durante a 1ª semana de vida, em comparação aos RNs a termo 1,2 . A hiperbilirrubinemia nessas crianças é mais prevalente e intensa, podendo acarretar consequências graves devido à neurotoxicidade que ocorre em menor tempo de vida em

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“…This database has been used previously to examine health outcomes in both adult and pediatric populations. [28][29][30][31][32] …”

Section: Data Source and Linkagementioning

confidence: 99%

Trends and Outcomes of Adolescent Bariatric Surgery in California, 2005–2007

Jen

Rickard²,

Shew³

et al. 2010

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:There has been a dramatic increase in the use of adolescent bariatric surgery. However, previous studies were unable to distinguish laparoscopic versus open procedures. Furthermore, the use of laparoscopic adjustable gastric banding (LAGB) has not been studied on a population level. WHAT THIS STUDY ADDS:The rate of LAGB increased sevenfold from 2005 to 2007 with a corresponding decrease in the rate of laparoscopic Roux-en-Y gastric bypass. Furthermore, white adolescents represented only 28% of those who were overweight but accounted for 65% of the procedures.abstract OBJECTIVE: The goal of this study was to evaluate trends, and outcomes of adolescents who undergo bariatric surgery. PATIENTS AND METHODS: RESULTS:Overall, 590 adolescents (aged 13-20 years) underwent bariatric surgery in 86 hospitals. White adolescents represented 28% of those who were overweight but accounted for 65% of the procedures. Rates of laparoscopic adjustable gastric banding (LAGB) increased 6.9-fold from 0.3 to 1.5 per 100 000 population (P Ͻ .01), whereas laparoscopic Roux-en-Y gastric bypass (LRYGB) rates decreased from 3.8 to 2.7 per 100 000 population (P Ͻ .01). Self-payers were more likely to undergo LAGB (relative risk [RR]: 3.51 [95% confidence interval: 2.11-5.32]) and less likely to undergo LRYGB (RR: 0.45 [95% confidence interval: 0.33-0.58]) compared with privately insured adolescents. The rate of major in-hospital complication was 1%, and no deaths were reported. Of the patients who received LAGB, 4.7% had band revision/removal. In contrast, 2.9% of those who received LRYGB required reoperations. CONCLUSIONS:White adolescent girls disproportionately underwent bariatric surgery. Although LAGB has not been approved by the US Food and Drug Administration for use in children, its use has increased dramatically. There was a complication rate and no deaths. Long-term studies are needed to fully assess the efficacy, safety, and health care costs of these procedures in adolescents.

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Readmission for Neonatal Jaundice in California, 1991–2000: Trends and Implications

Cited by 85 publications

References 23 publications

Measuring End-Tidal Carbon Monoxide of Jaundiced Neonates in the Birth Hospital to Identify Those with Hemolysis

Measuring End-Tidal Carbon Monoxide of Jaundiced Neonates in the Birth Hospital to Identify Those with Hemolysis

Systematic follow-up of hyperbilirubinemia in neonates with a gestational age of 35 to 37 weeks

Trends and Outcomes of Adolescent Bariatric Surgery in California, 2005–2007

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