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Mandating longer hospital stays for newborns may not be the best way to prevent readmissions for jaundice

The drive to contain health care costs has dramatically shortened routine hospital stays for mothers and newborns. While just 36 percent of newborns in Washington State were discharged less than 30 hours after birth in 1991, 88 percent were discharged this early in 1995. Infants discharged this early are at higher risk of hospital readmissions related to newborn jaundice, which typically doesn't show up during the first 3 days of life.

A recent study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00034) found that the 750 healthy infants sent home less than 30 hours after birth were 34 percent more apt to be readmitted to the hospital for jaundice within the first 2 weeks of life than the 3,192 healthy infants discharged 30 to 78 hours after birth, after adjusting for other factors affecting risk of jaundice.

On the other hand, there was no difference in how long the readmitted infants stayed in the hospital or risk of jaundice-related complications between early and late-discharge infants. In fact, the clinical significance of these readmissions was limited. Based on a 2.5 percent prevalence of jaundice in the healthy infants studied, 122 infants would have to remain in the hospital for longer than 30 hours to avoid one jaundice readmission. Thus, mandating longer neonatal stays (for example, current State and Federal laws mandating insurance coverage for 48-hour maternal and infant stays) may not be the most effective way to prevent hospital readmission for jaundice and its complications.

Instead, facilitating a safe transition from the hospital to the home and providing adequate support for early-discharge infants may be both medically and economically beneficial, conclude the University of Washington researchers. Led by Jacqueline Grupp-Phelan, M.D., M.P.H., currently with Children's Hospital Medical Center in Cincinnati, they used Washington State vital statistics data, birth data, and hospital discharge data from 1991 to 1995 to analyze the relationship between time of neonatal discharge and hospital jaundice readmission.

See "Early newborn hospital discharge and readmission for mild and severe jaundice," by Dr. Grupp-Phelan, James A. Taylor, M.D., Lenna L. Liu, M.D., M.P.H., and Robert L. Davis, M.D., M.P.H., in the December 1999 Archives of Pediatric and Adolescent Medicine 153, pp. 1283-1288.

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