Newborn Readmissions May Largely Be Preventable

Joe Barber Jr, PhD

April 08, 2013

Potentially preventable problems including jaundice and feeding problems account for the majority of hospital readmissions among newborns within 28 days after discharge, according to the findings of a retrospective study.

Paul C Young, MD, from the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, and colleagues published their findings online April 8 in Pediatrics.

"From the perspectives of parents, physicians, and payers, an unplanned, unexpected readmission within a few weeks after discharge of an ostensibly healthy newborn from a well baby nursery (WBN) is an undesirable event," the authors write. "As suggested in the [American Academy of Pediatrics] statement, such a readmission may reflect an inadequate assessment of the newborn's readiness for discharge, a lack of resources and/or an inability of a parent to provide early newborn care, or inappropriate and/or untimely availability of, or access to, outpatient care."

In the study, the authors used the Intermountain Healthcare Enterprise Data Warehouse to identify newborns with gestational ages of 34 to 42 weeks who were discharged from an Intermountain Healthcare hospital between 2000 and 2010, excluding those who spent more than 24 hours in or were discharged from a neonatal intensive care unit. Among the 296,114 newborns discharged, 5308 (17.9/1000) were readmitted within the next 28 days.

Among the 5308 readmitted newborns, the most common causes of readmission were feeding problems (40.9%), jaundice (35.3%), respiratory distress (33%), potential sepsis (22.5%), and infection (21.2%), with many newborns having multiple causes for readmission. Compared with term newborns (readmission rate, 14.8/1000), both late preterm (readmission rate, 34.6/1000; P < .001) and early term (readmission rate, 20.6/1000; P < .001) newborns had significantly higher rates of readmission.

Among the 21 Intermountain Healthcare hospitals, the readmission rate varied from 7.9/1000 to 44.6/1000, and 9 hospitals had readmission rates that were significantly different from the mean of 17.9/1000 (5 hospitals were significantly lower and 4 were significantly higher).

Multivariate analysis adjusted for estimated gestational age or the proportion of late preterm newborns did not reveal a significant influence of either factor on readmission rates. In the study, the mean expenditure associated with a readmission was $4548 ± $8893, with a wide range from $382 to $31,784.

The limitations of the study included the selection of newborns from a single hospital system in Utah, potentially limiting generalizability; lack of information regarding particular hospital policies such as routine NICU admission for late preterm babies; and a lack of data on outpatient visits to primary care physicians.

"In a large health care system in Utah, we found that, over an 11-year period, 18 of 1000 newborns with gestational ages between 34 and 42 weeks who were cared for in WBNs were readmitted within their first 4 weeks of life," the authors write. "Feeding problems and jaundice were the most common diagnoses associated with readmission, and most of these occurred within 1 to 2 weeks of discharge. These findings suggest that when considering readiness for discharge of a newborn, one should carefully assess whether the infant is at risk for feeding problems and jaundice."

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online April 8, 2013. Abstract