Summary of Workshop: Early Discharge and Neonatal Hyperbilirubinemia

The National Institute of Child Health and Human Development and the Agency for Health Care Policy and Research convened a workshop addressing the issues related to early discharge and hyperbilirubinemia on March 28, 1995. Recent reports have suggested that a high proportion of hospital readmissions in the neonatal period are related to hyperbilirubinemia.1-3 In addition, a growing number of anecdotal reports have raised concern about a resurgence of kernicterus and other hyperbilirubinemia-related morbidity, much of which may be preventable with improved neonatal discharge practices, monitoring technologies, and/or new pharmacologic therapies.4 Cost-containment strategies, such as managed care, have resulted in a continued trend toward shorter lengths of stay for all hospitalizations in all age groups. As a part of this trend, early discharge of neonates has also become common. The potential effects of these policies on subsequent outcomes for neonates and their mothers have generated concern. (In fact, Maryland has recently passed, and other states have introduced, legislation mandating at least 2 days postnatal hospital care.5) In addition to hyperbilirubinemia, other health issues related to early discharge that have been identified were discussed. These are reviewed in this issue of Pediatrics.6 They include potential adverse effects on newborn screening, poor preparation for breast-feeding, inadequate surveillance of mothers and neonates for health problems in the postpartum/neonatal period, reduced opportunities for parent training in "at-risk" populations, disruption of immunization practices, and shifting of economic burdens to families and nonhospital-based providers. The objectives of this workshop were: a) to review the present status of knowledge regarding hyperbilirubinemia requiring clinical intervention in the newborn and its prevention, and b) in the context of current practices, to begin outlining an agenda for research needs, practice guidance, and policy formulation related to morbidity and mortality associated with early discharge and neonatal jaundice.