Newborn Weight Loss Tool and Readmission for Hyperbilirubinemia

Abstract

Objective The aim of this study was to determine if the Newborn Weight Loss Tool (NEWT) can predict hospital readmission due to hyperbilirubinemia.

Study Design This is a case–control study of 93 newborns and 186 controls ≥35 weeks' gestation. All were discharged from the Mother–Baby unit of an urban academic center and subsequently readmitted for hyperbilirubinemia. Controls were matched for date of birth, gestational age, and Bhutani risk zone. All infants were screened for hyperbilirubinemia prior to discharge and managed according to American Academy of Pediatrics guidelines in place at the time. Chi-square, Fisher's exact test, and multivariate analysis were utilized as appropriate.

Results There was no significant difference between the groups for a NEWT < 50% at discharge. More cases than controls breastfed. A significantly greater percentage of cases had NEWT > 50% at readmission than discharge. NEWT > 90% was moderately associated with readmission for hyperbilirubinemia (p = 0.081).

Conclusion NEWT provides a more nuanced assessment of weight loss following birth and can aid in highlighting newborns at risk for readmission due to hyperbilirubinemia.

Key Points

• Weight loss is a risk factor for readmission after birth.

• NEWT is a more nuanced assessment of weight loss.

• NEWT > 90% is associated with readmission for jaundice.

Keywords

hyperbilirubinemia - newborn - hospital readmission - Newborn Weight Loss Tool

Authors' Contributions

M. I. conceived the study, reviewed the drafts, provided critical comments, approved the version to be published, and agreed to be accountable for all aspects of the work. D. L. S. drafted much of the manuscript, collected data, approved the version to be published, and agreed to be accountable for all aspects of the work. N. K. drafted parts of the manuscript, collected data, provided critical comments, approved the version to be published, and agreed to be accountable for all aspects of the work. A. S., D. W., J. S., M. P., and R. B. collected data, provided critical comments, approved the version to be published, and agreed to be accountable for all aspects of the work.

Publication History

Received: 09 October 2022

Accepted: 19 October 2022

Article published online:
29 December 2022

• References

• 1 Blumovich A, Mangel L, Yochpaz S, Mandel D, Marom R. Risk factors for readmission for phototherapy due to jaundice in healthy newborns: a retrospective, observational study. BMC Pediatr 2020; 20 (01) 248-253
• 2 Bhutani VK, Johnson L. Kernicterus in the 21st century: frequently asked questions. J Perinatol 2009; 29 (Suppl. 01) S20-S24
• 3 Maisels MJ, Kring E. Length of stay, jaundice, and hospital readmission. Pediatrics 1998; 101 (06) 995-998
• 4 Schiltz NK, Finkelstein Rosenthal B, Crowley MA. et al. Rehospitalization during the first year of life by insurance status. Clin Pediatr (Phila) 2014; 53 (09) 845-853
• 5 Lain SJ, Roberts CL, Bowen JR, Nassar N. Early discharge of infants and risk of readmission for jaundice. Pediatrics 2015; 135 (02) 314-321
• 6 Karnati S, Kollikonda S, Abu-Shaweesh J. Late preterm infants - changing trends and continuing challenges. Int J Pediatr Adolesc Med 2020; 7 (01) 36-44
• 7 Macdonald PD, Ross SRM, Grant L, Young D. Neonatal weight loss in breast and formula fed infants. Arch Dis Child Fetal Neonatal Ed 2003; 88 (06) F472-F476
• 8 Paul IM, Lehman EB, Hollenbeak CS, Maisels MJ. Preventable newborn readmissions since passage of the Newborns' and Mothers' Health Protection Act. Pediatrics 2006; 118 (06) 2349-2358
• 9 Flaherman VJ, Schaefer EW, Kuzniewicz MW, Li SX, Walsh EM, Paul IM. Early weight loss nomograms for exclusively breastfed newborns. Pediatrics 2015; 135 (01) e16-e23
• 10 Miller JR, Flaherman VJ, Schaefer EW. et al. Early weight loss nomograms for formula fed newborns. Hosp Pediatr 2015; 5 (05) 263-268
• 11 American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114 (01) 297-316
• 12 Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics 1999; 103 (01) 6-14
• 13 Bhutani VK, Maisels MJ, Schutzman DL. et al. Identification of risk for neonatal haemolysis. Acta Paediatr 2018; 107 (08) 1350-1356
• 14 Campbell Wagemann S, Mena Nannig P. Severe hyperbilirubinemia in newborns, risk factors and neurological outcomes [in Spanish]. Rev Chil Pediatr 2019; 90 (03) 267-274
• 15 Chang RJ, Chou HC, Chang YH. et al. Weight loss percentage prediction of subsequent neonatal hyperbilirubinemia in exclusively breastfed neonates. Pediatr Neonatol 2012; 53 (01) 41-44
• 16 Bertini G, Dani C, Tronchin M, Rubaltelli FF. Is breastfeeding really favoring early neonatal jaundice?. Pediatrics 2001; 107 (03) E41
• 17 Salas AA, Salazar J, Burgoa CV, De-Villegas CA, Quevedo V, Soliz A. Significant weight loss in breastfed term infants readmitted for hyperbilirubinemia. BMC Pediatr 2009; 9: 82-87
• 18 Burgos AE, Schmitt SK, Stevenson DK, Phibbs CS. Readmission for neonatal jaundice in California, 1991-2000: trends and implications. Pediatrics 2008; 121 (04) e864-e869
• 19 Bhutani VK, Stark AR, Lazzeroni LC. et al; Initial Clinical Testing Evaluation and Risk Assessment for Universal Screening for Hyperbilirubinemia Study Group. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatr 2013; 162 (03) 477-482.e1
• 20 Kemper AR, Newman TB, Slaughter JL. et al. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2022; 150 (03) e2022058859