TREATMENT OF INFANTS WITH INDIRECT HYPERBILIRUBINEMIA - READMISSION TO BIRTH HOSPITAL VS NONBIRTH HOSPITAL

Background/Objective: Indirect hyperbilirubinermia is a common cause f or readmission to a hospital during the first week of life. Many newbo rn nurseries are ill equipped to readmit such newborns. The purpose of this study was to compare the care and treatment of infants with indi rect hyperbilirubinemia who were readmitted to their birth hospital wi th those who were admitted to a hospital that differed from their birt h hospital. Design: Retrospective cohort study. Setting: Children's an d community hospitals. Patients: We reviewed the records of 100 newbor ns who were readmitted during the first week of life (36 were readmitt ed to their birth hospital) with a primary admission diagnosis of indi rect hyperbilirubinemia. Results: Infants who were admitted to their b irth hospital were less likely to have blood cultures (none of 36 vs 1 7 of 64, P=.0005), urine cultures (none of 36 vs eight of 64, P=.02), or more than one complete blood cell count (two of 36 vs 18 of 64, P=. 001) performed compared with infants who were admitted to a nonbirth h ospital. Antibiotic, intravenous therapy (P=.0005), and emergency depa rtment (P=.0001) use was more common among infants who were admitted t o a nonbirth hospital. Infants who were admitted through the emergency department at a nonbirth hospital had phototherapy started later (mea n+/-SD, 5.3+/-1.6 vs 2.2+/-1.7 hours; P=.0001) than did infants who we re directly readmitted to the same nonbirth hospital. Conclusions: Rea dmitting infants with indirect hyperbilirubinemia to birth hospitals o r ensuring that accurate, timely, and complete information is obtained from the birth centers by admitting hospital personnel before laborat ory studies and treatment are performed will reduce diagnostic workups and should reduce hospital charges for these infants. Phototherapy sh ould be initiated in the emergency department if stabilization is requ ired before admission.