Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e864-e869 (doi:10.1542/peds.2007-1214)
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ARTICLE

Readmission for Neonatal Jaundice in California, 1991–2000: Trends and Implications

Anthony E. Burgos, MD, MPHa, Susan K. Schmitt, PhDb, David K. Stevenson, MDa and Ciaran S. Phibbs, PhDb,c

a Departments of Pediatrics
b Health Research and Policy, Stanford University, Stanford, California
c Veterans’ Administration Hospital, Palo Alto, California

OBJECTIVE. We sought to describe population-based trends, potential risk factors, and hospital costs of readmission for jaundice for term and late preterm infants.

METHODS. Birth-cohort data were obtained from the California Office of Statewide Health Planning and Development and contained infant vital statistics data linked to infant and maternal hospital discharge summaries. The study population was limited to healthy, routinely discharged infants through the use of multiple exclusion criteria. All linked readmissions occurred within 14 days of birth. International Classification of Diseases, Ninth Revision, codes were used to further limit the sample to readmission for jaundice. Hospital discharge records were the source of diagnoses, hospital charges, and length-of-stay information. Hospital costs were estimated using hospital-specific ratios of costs to charges and adjusted to 1991.

RESULTS. Readmission rates for jaundice generally rose after 1994 and peaked in 1998 at 11.34 per 1000. The readmission rate for late preterm infants (as a share of all infants) over the study period remained at <2 per 1000. Factors associated with increased likelihood of hospital readmission for jaundice included gestational age 34 to 39 weeks, birth weight of <2500 g, male gender, Medicaid or private insurance, and Asian race. Factors associated with a decreased likelihood of readmission for jaundice were cesarean section delivery and black race. The mean cost of readmission for all infants was $2764, with a median cost of $1594.

CONCLUSIONS. Risk-adjusted readmission rates for jaundice rose following the 1994 hyperbilirubinemia guidelines and declined after postpartum length-of-stay legislation in 1998. In 2000, the readmission rate remained 6% higher than in 1991. These findings highlight the complex relationship among newborn physiology, socioeconomics, race or ethnicity, public policy, clinical guidelines, and physician practice. These trend data provide the necessary baseline to study whether revised guidelines will change practice patterns or improve outcomes. Cost data also provide a break-even point for prevention strategies.

Key Words: jaundice • neonatal • population-based studies • readmission rates • risk factors

Abbreviations: AAP—American Academy of Pediatrics • OSHPD—California Office of Statewide Health Planning and Development • ICD-9—International Classification of Diseases, Ninth Revision • OR—odds ratio • HMO—health maintenance organization • PPO—preferred provider organization

Accepted Sep 6, 2007.