P0773 - Trends in Hospitalization for Neonatal Jaundice and Kernicterus in the United States, 2006-2017

Background: The American Academy of Pediatrics reissued its guidelines on the management of jaundice in newborns born at ≥35 weeks gestation in 2004. The impact of this on the management of jaundice and the incidence of kernicterus in the United States (US) is unknown

Objective: To examine the trends in hospitalization for neonatal jaundice and kernicterus and their associated resource utilization in the United States from 2006 to 2017
Design/

Methods: This was a retrospective, serial cross-sectional study using data from the National Inpatient Sample. All newborn hospitalizations with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9-CM) or ICD10-CM code for jaundice or kernicterus and admitted at age ≤28 days were included. Cases of kernicterus were further required to have a procedure code for phototherapy or exchange transfusion. Newborns with polycythemia who had exchange transfusion were excluded. Transfers were excluded to avoid double counting. The outcome measures were incidence of jaundice (expressed as a proportion), the incidence of kernicterus (expressed as per 100,000 live births), length of stay (LOS), and inflation-adjusted hospital cost. Survey logistic regression was used to estimate trends over time. P-value <0.05 was considered significant

Results: A total of 47,979,909 neonatal hospitalizations were identified from 2006-2017, of which 20.2% had jaundice, and 325 had kernicterus (0.7 per 100,000 live births). While the incidence of jaundice remained stable at 20.1-20.5% (P=0.1), the proportion with jaundice who received phototherapy increased from 22.1% to 27.2% (aOR = 1.08; 95% confidence interval (CI), 1.04-1.12) between 2006-08 and 2015-17 (Figure 1). The incidence of kernicterus increased from 0.7 to 0.8 per 100,000 live births but this was not significant in adjusted analysis (aOR = 1.07; 95% CI, 0.84-1.36). Hospitalization in the South census region was associated with decreased odds of kernicterus (aOR = 0.41; 95% CI, 0.2–0.86) [Table 1]. The overall LOS was 2.3 days (IQR, 1.5–4.2) for jaundice and 4 days (IQR, 2.0-6.5) for kernicterus. Median hospital cost was $1563 for jaundice and $4,888 for kernicterus (Table 2)
Conclusion(s): While the overall incidence of jaundice remained stable, the use of phototherapy significantly increased during the study. Kernicterus, although rare during the study, remained stable during the study period. Further clinical and epidemiological research is needed to understand the factors that mitigate against the eradication of this condition