Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. 2349-2358 (doi:10.1542/10.1542/peds.2006-2043)
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ARTICLE

Preventable Newborn Readmissions Since Passage of the Newborns’ and Mothers’ Health Protection Act

Ian M. Paul, MD, MSca, Erik B. Lehman, MSa, Christopher S. Hollenbeak, PhDa and M. Jeffrey Maisels, MB, BChb

a Pennsylvania State University College of Medicine, Hershey, Pennsylvania
b William Beaumont Hospital, Royal Oak, Michigan

BACKGROUND. Congress passed the Newborns’ and Mothers’ Health Protection Act in 1996, reversing the trend of shorter newborn nursery lengths of stay. Hope existed that morbidities would lessen for this vulnerable population, but some reports indicate that the timeliness and quality of postdischarge care may have worsened in recent years.

OBJECTIVE. Our goal was to determine risk factors for the potentially preventable readmissions because of jaundice, dehydration, or feeding difficulties in the first 10 days of life in Pennsylvania since passage of the Newborns’ and Mothers’ Health Protection Act.

PATIENTS AND METHODS. Birth records from 407826 newborns ≥35 weeks’ gestation from 1998 to 2002 were merged with clinical discharge records. A total of 2540 newborns rehospitalized for jaundice, dehydration, or feeding difficulties in the first 10 days of life were then compared with 5080 control infants. Predictors of readmission were identified by using multiple logistic regression analysis.

RESULTS. An unadjusted comparison of baseline characteristics revealed numerous predictors of readmission. Subsequent adjusted analysis revealed that Asian mothers, those 30 years of age or older, nonsmokers, and first-time mothers were more likely to have a readmitted newborn, as were those with diabetes and pregnancy-induced hypertension. For neonates, female gender and delivery via cesarean section were protective for readmission, whereas vacuum-assisted delivery, gestational age <37 weeks, and nursery length of stay <72 hours were predictors of readmission in the first 10 days of life.

CONCLUSIONS. Although readmissions for jaundice, dehydration, and feeding difficulties may be less common for some minority groups and Medicaid recipients in the era of the Newborns’ and Mothers’ Health Protection Act compared with nonminorities or privately insured patients, several predictors of newborn readmission have established associations with inexperienced parenting and/or breastfeeding difficulty. This is one indication that this well-intentioned legislation and current practice may not be sufficiently protecting the health of newborns and suggests that additional support for mothers and newborns during the vulnerable postdelivery period may be indicated.

Key Words: newborn • hospital readmission • jaundice • dehydration

Abbreviations: NMHPA—Newborns’ and Mothers’ Health Protection Act • LOS—length of stay • AAP—American Academy of Pediatrics • PDOH—Pennsylvania Department of Health • PHC4—Pennsylvania Health Care Cost Containment Council • CI—confidence interval • OR—odds ratio

Accepted Aug 24, 2006.


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