Risk Adjustment for Neonatal Surgery: A Method for Comparison of In-Hospital Mortality
- 1 September 2012
- journal article
- research article
- Published by American Academy of Pediatrics (AAP) in Pediatrics
- Vol. 130 (3), e568-e574
- https://doi.org/10.1542/peds.2011-3647
Abstract
OBJECTIVE: Predischarge bilirubin screening predicts neonatal hyperbilirubinemia. We evaluated the incidence of false-negative bilirubin screening among readmissions for hyperbilirubinemia. METHODS: In healthy term and late preterm, predominantly breastfeeding newborns, predischarge transcutaneous bilirubin values were plotted on the hour of life–specific bilirubin nomogram and confirmed with plasma total bilirubin in those with a transcutaneous reading ≥75th percentile, or between the 41st and 75th percentiles in the presence of predictive icterogenic risk factors. False-negative bilirubin screen was defined as a predischarge bilirubin value ≤75th percentile in a newborn who was subsequently readmitted for phototherapy. RESULTS: Of a total of 25 439 neonates born between 2008 and 2009, 143 (0.56%) were readmitted with a mean plasma total bilirubin of 18.7 ± 1.7 mg/dL at 125 ± 54 hours. False-negative predischarge bilirubin screen was identified in 46 (32.2%). Of these, 6 (4.2%) were in the low-risk zone (≤40th percentile, relative risk [RR] = 1) and 40 (28%) in the intermediate-low–risk zone (41st–75th percentile, RR 7.62 [95% confidence interval 3.23–17.96]). Of those in the high-risk zones, 76 (53.1%) were in the intermediate-high–risk zone (76th–95th percentile, RR 25.32 [11.03–58.10]) and 21 (14.7%) in the high-risk zone (>95th percentile, RR 27.78 [11.23–68.70]). CONCLUSIONS: Predischarge bilirubin levels in newborns classified as low risk did not eliminate the risk of readmission for hyperbilirubinemia. All newborns including those at low risk must be vigilantly observed for subsequent hyperbilirubinemia.Keywords
This publication has 14 references indexed in Scilit:
- Impact of Hospital Volume on In-Hospital Mortality of Infants Undergoing Repair of Congenital Diaphragmatic HerniaAnnals of Surgery, 2010
- Benchmarking the quality of care of infants with low-risk gastroschisis using a novel risk stratification indexSurgery, 2010
- A Risk Adjustment Method for Newborns Undergoing Noncardiac SurgeryAnnals of Surgery, 2010
- Necrotizing Enterocolitis in 20 822 Infants: Analysis of Medical and Surgical TreatmentsClinical Pediatrics, 2010
- Effect of hospital case volume on outcome in congenital diaphragmatic hernia: the experience of the Canadian Pediatric Surgery NetworkJournal of Pediatric Surgery, 2009
- Identifying neonates at a very high risk for mortality among children with congenital diaphragmatic hernia managed with extracorporeal membrane oxygenationJournal of Pediatric Surgery, 2009
- Mortality in micro-premature infants with necrotizing enterocolitis treated by primary laparotomy is independent of gestational age and birth weightPediatric Surgery International, 2008
- Laparotomy versus Peritoneal Drainage for Necrotizing Enterocolitis and PerforationNew England Journal of Medicine, 2006
- Laparotomy Versus Peritoneal Drainage for Necrotizing Enterocolitis or Isolated Intestinal Perforation in Extremely Low Birth Weight Infants: Outcomes Through 18 Months Adjusted AgePediatrics, 2006
- Postoperative Outcomes of Extremely Low Birth-Weight Infants With Necrotizing Enterocolitis or Isolated Intestinal PerforationAnnals of Surgery, 2005