LENGTH OF STAY, JAUNDICE, AND HOSPITAL READMISSION

Objective. To evaluate the effect of postnatal age at the time of disc harge on the risk of readmission to hospital with specific reference t o readmission for hyperbilirubinemia. Design. Case-control study based on chart review. Setting. Large suburban community hospital in southe astern Michigan, delivering more than 5000 infants annually. Patients. Newborn infants, born between December 1, 1988, and November 30, 1994 , who were readmitted to hospital within 14 days of discharge, were co mpared with a randomly selected control group who were not readmitted. Results. Of 29 934 infants discharged, 247 (0.8%) were readmitted by the age of 14 days. One hundred twenty-seven (51%) were admitted becau se of hyperbilirubinemia and 74 (30%) with the diagnosis of ''rule out sepsis.'' The factors associated with an increased risk of readmissio n to the hospital were: infant of diabetic mother [odds ratios (OR), 3 .45; 95% confidence limits (CL), 1.39 to 8.60]; gestation less than or equal to 36 weeks (OR, 4.56; CL, 1.45 to 14.33), and 371/7 to 38 week s (OR, 2.95; CL, 1.63 to 5.35) versus greater than or equal to 40 week s; presence of jaundice in the nursery (OR, 1.73; CL, 1.14 to 2.63); b reastfeeding (OR, 1.78; CL, 1.13 to 2.81); male sex (OR, 1.58; CL, 1.0 7 to 2.34); length of stay <48 hours (OR, 1.91; CL, 1.15 to 3.16) and 48 to <72 hours (OR, 2.09; CL, 1.25 to 3.50) versus greater than or eq ual to 72 hours. Factors associated with readmission for jaundice were gestation less than or equal to 36 weeks (OR, 13.2; CL, 2.70 to 64.6) , 361/7 to 37 weeks (OR, 7.7; CL, 2.69 to 22.0), 371/7 to 38 weeks (OR , 7.2; CL, 3.05 to 16.97) versus greater than or equal to 40 weeks; ja undice during nursery stay (OR, 7.80; CL, 3.38 to 18.0);length of stay <48 hours (OR, 2.40; CL, 1.09 to 5.30) and 48 to <72 hours (OR, 3.15; CL, 1.40 to 7.09) versus greater than or equal to 72 hours; male sex (OR, 2.89; CL, 1.46 to 5.74); and breastfeeding (OR, 4.21; CL, 1.80 to 9.87). Infants whose length of stay was <48 hours were at no greater risk for readmission for jaundice or other causes than those whose len gth of stay was greater than or equal to 48 hours to <72 hours. Conclu sions. Discharge at any time <72 hours significantly increases the ris k for readmission to hospital and the risk for readmission with hyperb ilirubinemia when compared with discharge after 72 hours. The American Academy of Pediatrics recommends that infants discharged <48 hours sh ould be seen by a health care professional within 2 to 3 days of disch arge. Our observations, as well as those of others, suggest that this recommendation should also be extended to those discharged at <72 hour s after birth. One approach to decreasing the risk of morbidity and re admission, particularly from hyperbilirubinemia, would be to help moth ers to nurse their infants more effectively from the moment of birth.