Risk Factors Associated with Readmission for Neonatal Hyperbilirubinemia

  Objective  To investigate the risk factors associated with readmission for neonatal hyperbilirubinemia.

  Methods  We retrospectively analyzed the data of 44 infants (study group) who were admitted twice for hyperbilirubinemia to Department of Pediatrics of Peking Union Medical College Hospital in the period from January 2000 to May 2014. Meanwhile, 100 infants admitted once for hyperbilirubinemia during the same period were randomly selected as control group. The two groups were compared in terms of birth weight, gestational age, feeding patterns, length of stay, time of phototherapy, level of bilirubin, blood glucose level, infection, hemolysis, and extravascular hemorrhage. The risk factors associated with readmission of neonates for hyperbilirubinemia were analyzed.

  Results  The gestational age of the study group was significantly lower than those of the control group (37.9±1.9)weeks vs. (38.9±1.1)weeks, P < 0.01, but there was no difference in gender or birth weight(both P > 0.05). The study group were diagnosed with hyperbilirubinemia significantly earlier than the control group (64.1±32.0)hours vs. (98.1±93.1)hours, P=0.022. The bilirubin levels of the study group upon admission and discharge were both significantly higher than those of the control group (266.8±73.5)μmol/L vs. (218.9±102.6)μmol/L, P=0.002; (193.2±23.9)μmol/L vs. (179.6±25.7)μmol/L, P=0.004. The cycle of phototherapy was significantly more and duration of phototherapy significantly longer in the study group compared with the control group (2.2±1.1)rounds vs. (1.4±0.6)rounds, P < 0.001; (43.1±26.1)hours vs. (29.1±13.1)hours, P=0.002. The average length of hospital stay and the period before bilirubin level reducing to normal range were significantly longer in the study group than in the control group (4.1±3.0)days vs. (2.5±1.2)days, P=0.002; (43.1±25.5)hours vs. (33.1±14.4)hours, P=0.021. In addition, the incidence of hypoglycemia was significantly higher in the study group than in the control group (16% vs. 10%, P=0.019).There was no significant inter-group differences in infection, hemolysis, or extravascular hemorrhage (all P > 0.05).

  Conclusions  Readmission for hyperbilirubinemia may be more likely to happen in infants with smaller gestational age, earlier occurrence of hyperbilirubinemia, higher level of bilirubin, longer duration of phototherapy, and hypoglycemia. Therefore, we suggest that the infants with the above-mentioned risk factors should be monitored for one more day after their bilirubin level decrease within the normal range, so as to prevent readmission.