Rehospitalization after birth: Patterns among infants of all gestations

Kaiser Permanente, Oakland, California, United States
Archives of Disease in Childhood (Impact Factor: 2.9). 03/2005; 90(2):125-31. DOI: 10.1136/adc.2003.039974
Source: PubMed


To analyse rehospitalisation of newborns of all gestations.
A total of 33,276 surviving infants of all gestations born between 1 October 1998 and 31 March 2000 at seven Kaiser Permanente Medical Care Program (KPMCP) delivery services were studied retrospectively.
Rehospitalisation rates within two weeks after nursery discharge ranged from 1.0% to 3.7%. The most common reason for rehospitalisation was jaundice. Among babies > or =34 weeks, the most important factor with respect to rehospitalisation was use of home phototherapy. Among babies who were not rehospitalised for jaundice, African-American race (adjusted odds ratio (AOR) = 0.56), and having a scheduled outpatient visit (AOR = 0.73) or a home visit (AOR = 0.59) within 72 hours after discharge were protective. Factors associated with increased risk were: being small for gestational age (AOR = 1.83), gestational age of 34-36 weeks without admission to the neonatal intensive care unit (AOR = 1.65), Score for Neonatal Acute Physiology, version II, > or =10 (AOR = 1.95), male gender (AOR = 1.24), having both a home as well as a clinic visit within 72 hours after discharge (AOR = 1.84), and birth facility (range of AORs = 1.52-2.36). Asian race was associated with rehospitalisation (AOR = 1.49) when all hospitalisations were considered, but this association did not persist if hospitalisations for jaundice were excluded.
In this insured population with access to integrated care, rehospitalisation rates for jaundice were strongly affected by availability of home phototherapy and by follow up. For other causes, moderate prematurity and follow up visits played a large role, but variation between centres persisted even after controlling for multiple factors. Future research should include development of better process measures for evaluation of follow up strategies.

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    • "Approximately 60–70% of the 4 million babies annually born in the United States suffer from jaundice; this rate is higher in neonates born in East Asia (Setia et al., 2012). Hyperbilirubinemia is a frequent cause of recurring hospitalization in the neonatal period (Escobar et al., 2005) and although this condition is short-lived, it is the reason for 75% of hospitalizations occurring within the first weeks after birth (Barbara, 2008). In a study undergone in Najmieh Hospital in Tehran in 2005 (Kavehmanesh et al., 2008), the rate of repeated hospitalization on account of jaundice was registered at 12.6%. "
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    ABSTRACT: Various therapeutic treatments have been prescribed for decreasing the bilirubin level. In this study, the effects of massage on serum bilirubin levels in term infants with hyperbilirubinemia undergoing phototherapy were evaluated. This clinical trial research was carried out on 34 full-term infants with hyperbilirubinemia undergoing phototherapy in 2009. The infants weighed between 2500–4000 g at birth and had bilirubin levels 13–24 mg/dl. The 34 infants hospitalized with hyperbilirubinemia were randomly assigned into a massage group comprising of 18 babies and a control group of 16, among which a total of 25 infants remained till the completion of the study. The mean bilirubin levels were monitored and compared in the two groups. A significant decrease between mean rates of bilirubin levels in the two groups was observed. While the bilirubin level was monitored at 17.89±2.12 mg/dl in the massage group on the day of admission to the study, it stood at 17.87±2.46 mg/dl in the control group (P=0.98), which was not significant statistically. However, the mean bilirubin level monitored on the fourth day of hospitalization showed a meaningful difference standing at 9.92±1.3 mg/dl and 11.97±1.52 mg/dl in the massage group and in the control group (P=0.001). The study has shown that massage therapy has a significant effect in decreasing the bilirubin level of infants suffering from hyperbilirubinemia undergoing phototherapy treatment.
    Full-text · Article · Feb 2014 · Nautilus -Greenville then Sanibel-
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    • "Severe neonatal jaundice (NNJ) or hyperbilirubinemia and its progression to acute bilirubin encephalopathy (ABE) and kernicterus is a leading, yet preventable, cause of newborn re-hospitalizations, deaths, and disabilities globally [1-5]. Phototherapy (PT), which involves exposing a newborn’s skin to electric lamp-generated blue light, is the standard treatment for removing excessive bilirubin, except in extreme cases when exchange transfusion becomes necessary [6]. "
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    ABSTRACT: Severe neonatal jaundice and its progression to kernicterus is a leading cause of death and disability among newborns in poorly-resourced countries, particularly in sub-Saharan Africa. The standard treatment for jaundice using conventional phototherapy (CPT) with electric artificial blue light sources is often hampered by the lack of (functional) CPT devices due either to financial constraints or erratic electrical power. In an attempt to make phototherapy (PT) more readily available for the treatment of pathologic jaundice in underserved tropical regions, we set out to test the hypothesis that filtered sunlight phototherapy (FS-PT), in which potentially harmful ultraviolet and infrared rays are appropriately screened, will be as efficacious as CPT.Methods/design: This prospective, non-blinded randomized controlled non-inferiority trial seeks to enroll infants with elevated total serum/plasma bilirubin (TSB, defined as 3 mg/dl below the level recommended by the American Academy of Pediatrics for high-risk infants requiring PT) who will be randomly and equally assigned to receive FS-PT or CPT for a total of 616 days at an inner-city maternity hospital in Lagos, Nigeria. Two FS-PT canopies with pre-tested films will be used. One canopy with a film that transmits 30 to 55 % blue light (wavelength range: 400 to 520 nm) will be used during sunny periods of a day. Another canopy with a film that transmits 79 to 83 % blue light will be used during overcast periods of the day. The infants will be moved from one canopy to the other as needed during the day with the goal of keeping the blue light irradiance level above 8 muW/cm2/nm.Primary outcome: FS-PT will be as efficacious as CPT in reducing the rate of rise in bilirubin levels. Secondary outcome: The number of infants requiring exchange transfusion under FS-PT will not be more than those under CPT. This novel study offers the prospect of an effective treatment for infants at risk of severe neonatal jaundice and avoidable exchange transfusion in poorly-resourced settings without access to (reliable) CPT in the tropics.Trial registration: Identifier: NCT01434810.
    Full-text · Article · Dec 2013 · Trials
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    • "Another medical record analysis, which included more than 33,000 infants born at seven different Kaiser Permanente Medical Care Program facilities, found that late preterm infants not admitted to the NICU were more likely than infants of all other gestational ages to be readmitted to the hospital within 2 weeks (adjusted odds ratio [AOR] = 3.10, 95% confidence interval [CI]: 2.38-4.02) (Escobar et al., 2005). The most frequent reasons for rehospitalization were jaundice (34%) and feeding difficulties (26%). "
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    ABSTRACT: To synthesize the published research pertaining to breastfeeding establishment and outcomes among late preterm infants and to describe the state of the science on breastfeeding within this population. Online databases Ovid MEDLINE, CINAHL, PubMed, and reference lists of reviewed articles. Nine data-based research articles examining breastfeeding patterns and outcomes among infants born between 34 0/7 and 36 6/7 weeks gestation or overlapping with this time period by at least 2 weeks. Effect sizes and descriptive statistics pertaining to breastfeeding initiation, duration, exclusivity, and health outcomes among late preterm breastfed infants. Among late preterm mother/infant dyads, breastfeeding initiation appears to be approximately 59% to 70% (U.S.), whereas the odds of breastfeeding beyond 4 weeks or to the recommended 6 months (exclusive breastfeeding) appears to be significantly less than for term infants, and possibly less than infants ≤34 to 35 weeks gestation. Breastfeeding exclusivity is not routinely reported. Rehospitalization, often related to "jaundice" and "poor feeding," is nearly twice as common among late preterm breastfed infants as breastfed term or nonbreastfed late preterm infants. Barriers to optimal breastfeeding in this population are often inferred from research on younger preterm infants, and evidence-based breastfeeding guidelines are lacking. Late preterm infants are at greater risk for breastfeeding-associated rehospitalization and poor breastfeeding establishment compared to their term (and possibly early preterm) counterparts. Contributing factors have yet to be investigated systematically.
    Preview · Article · Jan 2011 · Journal of Obstetric Gynecologic & Neonatal Nursing
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