1. Early Newborn Discharge and Readmission for Mild and Severe Jaundice Jacqueline Grupp-Phelan, James A. Taylor, Lenna L. Liu and Robert L. Davis University of Washington, Seattle, Washington Abstract Objective: A past study showed early newborn discharge places neonates at risk for readmission in the first 30 days of life. Because a large number of these readmissions were for jaundice, we sought to further explore the relationship of early newborn discharge and readmission for jaundice, and to see if early discharge was associated with increased severity of jaundice among those readmitted. Methods: We performed a population-based case-control study using Washington State vital statistic, birth certificate and hospital discharge abstracts from 1991-95. Cases were 750 infants readmitted for jaundice in the two first weeks of life, controls were 3,192 infants not readmitted. Infants with severe medical conditions and those status post cesarean section were excluded. “Early” discharge was defined as less than 30 hours and “late” discharge as 30 - 72 hours. We assessed the risk for jaundice readmission and for readmissions classified as brief (  2 days) or prolonged (  ) 2 days and for readmissions classified as uncomplicated or complicated. Logistic regression was used to determine the association between early discharge and readmission for jaundice. Results: Of 3,942 infants studied, 750 cases were readmitted for jaundice. Among cases, 503 infants (67%) were readmitted after “early” discharge, while among controls, 1910 (60%) were readmitted after “early” discharge (Odds Ratio (OR) 1.34, 95%CI 1.10, 1.64, adjusted for birth year, gestational age, maternal race and age, payer, and infant sex). Newborns discharged early were as likely to have a brief readmission (OR 1.35 95% CI 1.12,1.63) verses a prolonged readmission (OR 1.43 95% CI 1.01, 2.04). Newborns discharged early were as likely to have a non-complicated jaundice readmission (OR 1.23 95%CI 0.93, 1.62) verses a complicated jaundice readmission (OR 1.44 95%CI 1.17,1.78). Conclusions: While newborns discharged early are at increased risk for readmission for jaundice, the clinical significance is limited. Mandating longer neonatal stays may not be the most effective strategy to prevent readmission for jaundice and its complications. METHODS (con’t) Cases: 750 babies readmitted within 14 days for jaundice Controls: 3942 babies not readmitted frequency matched on date of birth Early discharge <30 hours post-partum Late discharge 30 - 72 hours post-partum Risk for readmission for jaundice after early discharge: Newborn Stay (Hours) Readmitted Not Readmitted Early (<30) 503 1910 Late (30-40) 247 1282 OR=1.34 95% CI 1.10-1.64 (adjusted for year of birth, type of payer, infant gender, maternal age, gestational age, and parity.) Subset Analyses: A trend toward increased risk for readmission for young maternal age: (p =0.11) Less than 17 years OR= 2.50 95% CI 1.00,6.41 Older mothers OR=1.32 95% CI 1.11,1.58 No increased risk of readmission for the following maternal characteristics: primip vs. multip OR=1.29 (1.0,1.7) vs. 1.51 (1.2,1.9) unmarried vs. married OR=1.39 (0.9,2.0) vs. 1.37 (1.1,1.6) There was no clear difference in risk for readmission after early discharge for infants discharged over a weekend vs. early in the week. Thurs-Sat OR=1.43 95% CI 1.11,1.85 Sun-Wed OR=1.31 95% CI 1.04,1.66 Length of Stay and Complications Upon readmission for jaundice, infants were at no greater risk for longer admissions: LOS  2 days OR=1.35 95% CI 1.12,1.63 LOS > 2 days OR=1.43 95% CI 1.01,2.04 Or for more severe complications: Non-severe admission OR=1.23 95% CI 0.93,1.62 Severe admission OR=1.44 95% CI 1.17,1.78 Number Needed to Treat Analysis 385 infants would need to stay > 30 hours to avoid one readmission due to early discharge RESULTS (con’t) Poster No. 307 For more information, contact: Jacqueline Grupp-Phelan, Department of Pediatrics Box 356320 Seattle, WA 98195 Tel. 206 543-3209 E-mail jgphelan@u.washington.edu Objectives To determine if early neonatal discharge is a risk factor for readmission for jaundice To determine if certain subgroups are at increased risk To determine if early neonatal discharge increases severity of jaundice Limitations Exact time of discharge is not available Breastfeeding and follow up information is not available Laboratory tests not accessible Conclusions Newborns discharged early are at increased risk for readmission for jaundice The clinical significance is limited Implications Mandating longer neonatal stays may not be the most effective strategy to prevent readmission for jaundice METHODS Population based case control study Data sources: Washington State Birth Events Record Database linked to Hospital Discharge Abstracts RESULTS Jaundice Complication Variable: kernciterusexchange transfusion sepsisdeath Analysis Unadjusted odds ratios calculated for: risk for readmissions classified as brief (  2 days) vs. prolonged (  ) 2 days uncomplicated vs. complicated readmission Logistic regression used to determine the association between early discharge and readmission for jaundice.