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Early Discharge Not Linked to Jaundice

Subj:    UCSF-Kaiser Study Finds Early Hospital Discharge of Newborn is Not
Linked to Infant Jaundice
Date:    97-05-21 15:24:32 EDT
From:    AOL News

"The trend toward shorter hospital stays has led both physicians and the public to raise concerns about health risks to newborns discharged within a day or two after birth. One of the most serious risks is extreme jaundice, or extreme hyperbilirubinemia, which can lead to brain damage if it is not treated," said Thomas B. Newman, MD, MPH, associate professor in the UCSF Departments of Epidemiology and Biostatistics and Pediatrics and the lead author of the study.

Jaundice occurs when bilirubin--a yellowish pigment that is a byproduct of the red blood cells--builds up in the blood system rather than being secreted from the liver into the intestine and out of the body.

Characterized by a yellowish cast to the skin, jaundice is very common in newborns because it often takes a few days for the baby's liver to function normally and adjust to life outside the womb. The bilirubin level normally can rise to 15-20 milligrams per deciliter (mg/dl) of blood in the first week after birth in healthy infants.

The accepted treatment for more serious cases of jaundice is phototherapy, a technique developed in the 1960s in which the infant is exposed to high-level light. The light stimulates the bilirubin to change to a compound that is easily excreted with the urine, thereby controlling the problem until the liver begins to function normally.

If jaundice is left untreated, high levels of bilirubin can develop in the blood and possibly be absorbed into the brain cells, leading to irreversible brain damage. Extreme jaundice that leads to brain damage, called kernicterus or bilirubin encephalopathy, occurs very rarely and only when the bilirubin level in the blood exceeds a level of 25-30 mg/dl. This condition can also lead to mental impairment, motor problems, and hearing loss, said Newman.

The UCSF-Kaiser study analyzed data from 34,840 infants over 16 months. The infants were all born alive at 11 Kaiser Permanente Hospitals in Northern California between January 1995 and April 1996 with birth weights of 4.4 pounds or more.

Results showed that of the study population, 54 infants (or 0.14 percent) had a total bilirubin reading of greater than or equal to 25 mg/dl, the cutoff point for extreme hyperbilirubinemia in this particular study.

"Results from our university-HMO collaboration can help define better preventive strategies. Although we found extreme hyperbilirubinemia to be very rare in this large population, some babies seemed more at risk. These were Asian infants, males, and those less mature at birth," noted Newman

"On the other hand, early discharge was not associated with extreme hyperbilirubinemia in the infants," concluded the UCSF researcher.

Gabriel J. Escobar, MD, a study co-investigator from Kaiser-Permanente, cautioned, "There are other issues to be considered with respect to early newborn discharge, however, such as dehydration, that must be taken into account prior to discharging an infant at any age."

The research team used patient database information to determine if any link existed between early hospital discharge of a newborn and extreme jaundice. Of the study infants, 33 percent were discharged less than 24 hours after being born.

The research results were reported at the annual meeting of the Pediatric Academic Societies, which took place in early May in Washington, DC.

Other co-investigators on the study team were Mary A. Armstrong, MS; Priscilla T. Branch, MPH; Bruce F. Folck; and Marla N. Gardner, BA, all from Kaiser Permanente of Northern California.

CONTACT:
University of California, San Francisco
Mary Jean Pramik, 415/476-2557