Readmission of Breastfed Infants in the First 2 Weeks of Life

Abstract

OBJECTIVE: Readmission of breastfeeding infants for hyperbilirubinemia and/or dehydration has been increasing in recent years. The purpose of the current study was to characterize the indications for and condition of these infants at readmission, and to determine factors present prior to initial hospital discharge which might have identified them to be at risk.

STUDY DESIGN: The records of 125 breastfeeding infants who were admitted to Children's Mercy Hospital from 1995 to 1997 in the first 2 weeks of life with diagnoses of hyperbilirubinemia, dehydration, or feeding problems were reviewed. Infants with hemolytic disease, infection, or other underlying causes were excluded.

At readmission, 80 infants had total bilirubin levels >342 μmol/l (20 mg/dl) and gestational age ≥38 weeks or total bilirubin levels >308 μmol/l (18 mg/dl) and gestational age <38 weeks. Forty-nine infants had a weight loss ≥12% from birth weight or a serum sodium concentration ≥145 mmol/l. Twenty-six infants had both hyperbilirubinemia and excessive weight loss or hypernatremia.

RESULTS: The mean gestational age of all infants was 38.6 weeks, 95% CI, 38.3 to 38.9 weeks. Mean length of initial hospital stay was 1.8 days (SD 1.03) for vaginally delivered infants compared with 3.4 days (SD 2.1) for those delivered by C-section (p=0.003). The Cesarean birth rate (9%) was disproportionally low in infants readmitted compared with overall C-section rate in Kansas City, MO (17%) (p=0.03). There was a significantly lower rate of readmission for infants whose initial hospital stay was ≥3 days (p=<0.002), but not for infants whose initial stay was ≥2 days (p=0.1). Infants admitted for hyperbilirubinemia only were at 38.3±1.6 weeks gestation compared with infants admitted for excessive weight loss or hypernatremia, 39.2±1.3 (p=0.06), and 1 day older, 5.4±1.9 days vs. 4.4±2.5 days (p=0.05).

CONCLUSION: This study confirms that prematurity and short hospital stays are risk factors for readmission of breastfeeding infants with hyperbilirubinemia and/or excessive weight loss and hypernatremia. An initial hospital stay ≥3 days was associated with a reduced risk for readmission of these infants.