Article Text

IS NEONATAL HYPERBILIRUBINEMIA A REASON FOR HOSPITAL READMISSION?
  1. A J Sybilski2,
  2. A Wolniewicz2,
  3. K Tolak-Omernik2,
  4. A Łagun2
  1. 1Department of The Prevention of Environmental Hazards, Medical University of Warsaw, Warsaw, Poland,
  2. 2Department of Paediatric and Neonatology, Central Clinical Hospital of Ministry of Internal Affairs, Warsaw, Poland

Abstract

Introduction Along with the recent trend toward shorter post delivery hospital stays has come an increase in complications from hyperbilirubinemia. Early hospital discharge practices have been associated with increased hospital readmission rates. Is it always indispensable and reasonable?

Aim To perform a retrospective analysis of causes of neonatal hyperbilirubinemia as a reason for readmission.

Methods Authors reviewed the charts of 193 children (72 girls and 121 boys; age 3–56 days), who were readmitted due to neonatal jaundice from 1996 to 2006. We scrutinized final diagnosis, serum bilirubin level in admission day, and length of hospitalization.

Results Infections were recognized as final diagnosis in 60.1% all infants (n = 116). The major infection diseases were urinary tract infection 54.1% (n = 63), pneumonia and/or bronchitis 28.4% (n = 33), omphalitis 8.6% (n = 10). The etiology of hyperbilirubinemia were unknown in 37.5% (n = 72). On admission day serum bilirubin levels were between 5.1–22.8 mg/dL (median 14.33 mg/dL): children with unknown etiology of jaundice, 13.35 mg/dL; infants with infection disease or other causes, 14.9 mg/dL. The length of hospitalization ranged from 1 to 29 days.

Conclusions Almost 40% of causes of neonatal hyperbilirubinemia, which was due to hospital readmission, are of unknown origin. The admission bilirubin level is not useable as a prognostic factor for discharged diagnosis. Owing to a dominant etiology of jaundice (urinary and lower respiratory tract infection), the process of reaching the diagnosis should be performed by a GP. This could reduce the necessity for hospital readmission due to neonatal hyperbilirubinemia.

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