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Hosp Pediatr. 2019 Feb;9(2):115-120. doi: 10.1542/hpeds.2018-0136. Epub 2019 Jan 3.

Phototherapy for Neonatal Unconjugated Hyperbilirubinemia: Examining Outcomes by Level of Care.

Author information

1
Harbor-University of California Los Angeles Medical Center, Torrance, California; efein@dhs.lacounty.gov.
2
Los Angeles Biomedical Research Institute, Torrance, California.
3
Department of Pediatrics, University of California, Los Angeles, Los Angeles, California.
4
Department of Health Care Administration, California State University of Long Beach, Long Beach, California.
5
Harbor-University of California Los Angeles Medical Center, Torrance, California.
6
Department of Pediatrics, University of California, Davis, Sacramento, California; and.
7
Department of Health Systems Science, Kaiser Permanente School of Medicine, Pasadena, California.

Abstract

OBJECTIVES:

Newborns hospitalized with unconjugated hyperbilirubinemia without critical comorbidities may receive intensive phototherapy (IP) in non-ICU levels of care, such as a mother-newborn unit, or ICU levels of care. Our aim was to compare outcomes between each level.

METHODS:

Using hospital discharge data from 2005 to 2011 in New York's State Inpatient Database, we performed multivariate analyses to compare outcomes that included total cost of hospitalization, length of stay, 30-day readmission rate after IP, and the number of cases of death, exchange transfusion, and γ globulin infusion. We included term newborns treated with IP in their first 30 days of life and without diagnosis codes for other critical illnesses. Explanatory variables included level of care, sex, race, insurance type, presence or absence of hemolysis, hospital, volume of IP performed at each hospital, and year of hospitalization.

RESULTS:

Ninety-nine percent of IP was delivered in non-ICU levels of care. Incidence of major complications was rare (≤0.1%). After adjusting for confounders, ICU level of care was not associated with difference in length of stay (relative risk: 1.2; 95% confidence interval [CI]: 0.91 to 1.15) or 30-day readmission rate (odds ratio: 0.74; 95% CI: 0.50 to 1.09) but was associated with 1.51 (95% CI: 1.47 to 1.56) times higher costs.

CONCLUSIONS:

For otherwise healthy term newborns with jaundice requiring IP, most received treatment in a non-ICU level of care, and those in intensive care had no difference in outcomes but incurred higher costs. IP guideline authors may want to be more prescriptive about IP level of care to improve value.

PMID:
30606776
PMCID:
PMC6350264
DOI:
10.1542/hpeds.2018-0136

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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