Between 12/1/88 and 11/30/94 29,934 infants were discharged from our well baby nurseries and 243 (0.8%) were readmitted at ≤ 14 days. Reasons for readmission were hyperbilirubinemia (53%), rule out sepsis (29%), apnea/cyanosis (7%), dehydration/failure to thrive (2.5%), other (8%). We compared obstetric and neonatal information on each case matched with a control - the next infant born of the same sex and within 100g of the birth weight of the case. Matched pairs logistic regression analysis revealed the following associations with readmission: lower gestation (in spite of weight matching, p <.001), jaundice in nursery (p =.003), LOS < 72hr (p =.004) and breast feeding (p =.022). LOS < 48hr (47% cases, 42% controls) was not significantly associated with readmission. As hyperbilirubinemia accounts for more than half of the readmissions it is not surprising that the factors associated with readmission are those strongly associated with hyperbilirubinemia. Furthermore, of all diagnoses responsible for readmission, only hyperbilirubinemia (n = 130) and dehydration/failure to thrive (n = 6) are potentially preventable and hyperbilirubinemia accounts for 96% of these cases. The risk of significant hyperbilirubinemia in this population is 4.3/1000 discharges, 17 times greater than the risk of dehydration/FTT(0.25/1000 discharges).

As we are unlikely to return to the era of 3 day postpartum stays, any attempt to deal with the issue of early discharge (< 72hrs) and neonatal morbidity should address primarily the prevention and treatment of neonatal jaundice both of which can now be achieved pharmacologically. However, prevention will require treating 996 infants unnecessarily (with a drug like tin mesoporphyrin) to prevent 4 from becoming significantly jaundiced. The alternative requires close surveillance and treatment of those with rising bilirubin levels on days 3-4. The feasibility, costs, risks and benefits of these 2 approaches should be explored. Elimination of neonatal jaundice as a reason for hospital readmission will, in essence, eliminate virtually all preventable hospitalization in the first 2 weeks of life.