HOSPITAL READMISSION DUE TO NEONATAL HYPERBILIRUBINEMIA

Severe neonatal hyperbilirubinemia can occur without apparent reason i n term healthy breast-fed infants and some develop kernicterus. The ai m of our study was to assess the incidence of severe hyperbilirubinemi a in term healthy newborns discharged from the hospital. From January 1 through December 31, 1994, 6705 infants were delivered at Bikur-Chol im and Misgav-Ladach Community Hospitals. All 1448 newborns discharged with a serum bilirubin level >10.0 mg/dL were instructed to return to the hospital within 3 days for follow-up, as well as bilirubin determ ination. Twenty-one newborns with a bilirubin level >18.0 mg/dL were i dentified and readmitted at mean +/- standard deviation (SD) 5.5 +/- 1 .8 (range, 5 to 10 days of life). This represents 1.7% of the 1220 inf ants who returned for follow-up examination. Mean +/- SD serum bilirub in levels at readmission were 19.6 +/- 2.5 mg/dL. All but one of the i nfants were breast-fed. No cases of ABO incompatibility were found and two newborns were glucose-6-phosphate dehydrogenase (G6PD)-deficient. Sepsis work-up and direct Coomb's tests were negative in all cases. N one had hemolysis or were found to have any cause for hyperbilirubinem ia other than breast-feeding. Phototherapy was provided in all but two cases, and an exchange transfusion was performed in one case. Three a dditional infants, with bilirubin levels <10 mg/dL at discharge, were readmitted due to hyperbilirubinemia. One was diagnosed with neonatal hepatitis. We conclude that, based on our study population, 0.36% of t erm infants may subsequently develop severe neonatal hyperbilirubinemi a in the first postnatal week. Adequate follow-up programs should be a vailable when early discharge of healthy term newborns is considered.