Mustafa Ali Akın, Sultan Kavuncuoğlu, Sibel Özbek, Esin Yıldız GÖK, Fahrettin Uysal, Serhat Güler, Erkut ÖZTÜRK

Erken taburcu olan yenidoğanlarda yeniden hastaneye yatış nedenleri ve sonuçları Orijinal Araştırma

Amaç: Dünyada 1990 lı yıllarda başlayan erken taburcu olma bunun sonucu nbsp; yenidoğanın tekrar hastaneye yatışı nbsp; ve ciddi morbiditeleri sorgulanmıştır Bu çalışmada amacımız; yılda 20 000 25 000 canlı doğumu gerçekleştiren merkezimizde erken taburcu olma nedeniyle tekrar yatırılan zamanında doğmuş yenidoğanların yatış sıklığını morbiditelerini ve sonuçlarını belirlemek nbsp; hiperfenilalaninemi taramasında geri çağırma oranları ile atlanan olgu olup olmadığını irdelemektir Gereç ve Yöntem: 2004 yılı içinde The American College of Obstetricians and Gynecologists ACOG ölçütlerine göre erken nbsp; taburcu edilen term nbsp; bebekler nbsp; çalışmaya alındı Yeniden yatış nedeni olarak kan değişim sınırına yakın hiperbilirübinemi hipernatremik dehidratasyon duktus arteriyozusa bağımlı Doğuştan Kalp Hastalığı DKH varlığı ölçüt olarak alındı Hiperfenilalaninemi taramasında erken taburcu edilip geri çağrılan tanısı atlanan hasta varlığı araştırıldı Bulgular: Hastanemizde 2004 yılı içinde doğan 20 813 bebekten 444 term yenidoğan doğumu takiben 2 950 si ise taburcu edildikten sonraki günlerde değişik sorunlar nedeniyle birimimize yatırıldı 2 950 olgunun içinden çalışma kapsamına nbsp; giren 111 hasta değerlendirildiğinde 87 si hiperbilirübinemi 7 2 si hipernatremik dehidatasyon 5 4 ü duktusa bağımlı DKH tanısı aldı Tüm olguların 86 sı ilk 7 günde 14 ü ise 8 28 günde yatırıldı Erken taburcu edilen zamanında doğmuş nbsp; yenidoğanlarda hiperfenilalaninemi taraması sonucu 2004 yılında geri çağırma oranı 0 1 olup tanısı atlanan olgu yoktu Çıkarımlar: Ünitemizin geri yatış oranı 15 olup çalışma kapsamına giren grupta sıklık 3 8 idi En sık yatış nedeni hiperbilirübinemi ikinci sırada hipernatremik dehidratasyondu Duktusa bağlı DKH da ölüm oranı 33 yüksek idi Atlanmış hiperfenilalaninemili olgu saptanmadı Anahtar kelimeler: erken taburcu olma hiperbilirubinemi hiperfenilalaninemi yeniden hastaneye yatış yenidoğan nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; nbsp; SummaryAim: Rehospitalization and serious morbidities resulting from early discharge in the 1990 s were questioned In this study our aim was to investigate the frequency of rehospitalization outcomes and morbidities of the early discharged newborns and to identify the recall rate and if there were any missed cases in hyperphenylalaninemia screening in our unit at which 20 000 25 000 deliveries occur each year Material and Method: Term babies born in 2004 and discharged early according to the ACOG American Comity of Obstetrics and Gynecology criteria were included in this study Rehospitalization criteria was defined as hyperbilirubinemia levels close to exchange limits hypernatremic dehydration ductus dependent congenital heart diseases Recall rate and possible missed diagnosis for hyperphenylalaninemia due to early discharge were investigated Results: 444 term newborns of 20 813 live births delivered in our hospital during 2004 were hospitalized following the labor while 2 950 of them were rehospitalized afterdischarge for several problems 111 patients out of 2 950 cases were included in the study and 87 of them had hyperbilirubinemia 7 2 hypernatremic dehydration and 5 4 ductus dependent congenital heart disease Among all cases 86 werere rehospitalized in the first 7 days and 14 between the 8th to 28th nbsp; days According to hyperphenylalaninemia screening results recall rate was 0 1 for early discharged term infants and there were no cases missed for diagnosis Conclusıons: The rehospitalization rate in our unit was 15 while it was 3 8 nbsp; among newborns in the study group The most frequent rehospitalization indication was hyperbilirubinemia followed by hypernatremic dehydration as the second Mortality rate was high in the ductus dependent congenital hearth disease 33 and there were not any case of hyperphenylalaninemia missed for diagnosis Keywords: early discharged hyperbilirubinemia hyperphenylalaninemia newborn rehospitalization

Anahtar Kelimeler:

erken taburcu olma, hiperbilirubinemi, hiperfenilalaninemi, yeniden hastaneye yatış, yenidoğan

Reasons and results of rehospitalisation of early discharged newborns Original Article

Aim: Rehospitalization and serious morbidities resulting from early discharge in the 1990 s were questioned In this study our aim was to investigate the frequency of rehospitalization outcomes and morbidities of the early discharged newborns and to identify the recall rate and if there were any missed cases in hyperphenylalaninemia screening in our unit at which 20 000 25 000 deliveries occur each year Material and Method: Term babies born in 2004 and discharged early according to the ACOG American Comity of Obstetrics and Gynecology criteria were included in this study Rehospitalization criteria was defined as hyperbilirubinemia levels close to exchange limits hypernatremic dehydration ductus dependent congenital heart diseases Recall rate and possible missed diagnosis for hyperphenylalaninemia due to early discharge were investigated Results: 444 term newborns of 20 813 live births delivered in our hospital during 2004 were hospitalized following the labor while 2 950 of them were rehospitalized afterdischarge for several problems 111 patients out of 2 950 cases were included in the study and 87 of them had hyperbilirubinemia 7 2 hypernatremic dehydration and 5 4 ductus dependent congenital heart disease Among all cases 86 werere rehospitalized in the first 7 days and 14 between the 8th to 28th nbsp; days According to hyperphenylalaninemia screening results recall rate was 0 1 for early discharged term infants and there were no cases missed for diagnosis Conclusıons: The rehospitalization rate in our unit was 15 while it was 3 8 nbsp; among newborns in the study group The most frequent rehospitalization indication was hyperbilirubinemia followed by hypernatremic dehydration as the second Mortality rate was high in the ductus dependent congenital hearth disease 33 and there were not any case of hyperphenylalaninemia missed for diagnosis Keywords: early discharged hyperbilirubinemia hyperphenylalaninemia newborn rehospitalization

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Millar KR, Gloor JE, Wellington N, et al. Early neonatal presentations to the pediatric emergency department. Pediatr Emerg Care 2000; 16: 145- 50.
Britton JR , Britton HL , Gronwaldt V. Early perinatal hospital discharge and parenting during infancy. Pediatrics 1999; 104: 1070- 6.
Malkin JD, Garber S, Broder MS, et al. Infant mortality and early postpartum discharge. Obs and Gynecology 2000; 96: 183- 8.
Maisels MJ, Kring E. Length of stay, jaundice and hospital readmission. Pediatrics 1998; 101: 995- 8.
Conclusıons: The rehospitalization rate in our unit was 15% while it was 3.8% among newborns in the study group. The most frequent
rehospitalization indication was hyperbilirubinemia followed by hypernatremic dehydration as the second. Mortality rate was high in the ductus
dependent congenital hearth disease (33%) and there were not any case of hyperphenylalaninemia missed for diagnosis. 1. Centers for Disease Control and Prevention. Trends in length
of stay for hospital deliveries United States. MMWR 1995; 44: 335- 7. 2.
Margolis HM. A critical review of studies of newborn discharge
timing. Clin Pediatr 1995; 34: 626- 34. 3.
Danielsen B , Castles AG, Damberg L, et al. Newborn discharge
timing and readmissions: California 1992-1995. Pediatrics 2000; 106: 31- 9. 4.
American Academy of Pediatrics (AAP) commitee on fetus
and newborn hospital stag for health term newborn. Pediatrics 2004; 113: 1434- 8. 5.
Bhutani V, Johnson L, Sivier E. Predictive ability of a predischarge
hour specific serum bilirubin for subsequent significant hyper
bilirubinemia in healthy term and near- term newborns. Pediatrics 1999; 103: 6- 8. 6.
İra D, Davis D, Ellis D. Avner fluid, electrolytes and acid-base
homeostasis. In: Avroy A, Fanaroff RJ. Martin (eds). Neonatal
Perinatal Medicine Diseases of the fetus and Infant. 7th edition.
St Louis: Mosby, 2002; 625 - 6. 7.
Lubchenco LO: A practical classification for newborn infants
by weight and gestational age. J Pediatr 1967; 7:159- 67. 8.
Lock M , Ray JG. Higher neonatal morbidity after routine
early hospital discharge: are we sending newborns home too
early? CMAJ 1999; 161: 249- 52. 9.
Bragg EJ, Rosenn B, Khoury J, et al. The effect of early discharge
after vaginal delivery on neonatal readmission rates. Obstet
and Gynecol 1997; 89: 930- 3.
Millar KR, Gloor JE, Wellington N, et al. Early neonatal presentations to the pediatric emergency department. Pediatr Emerg Care 2000; 16: 145- 50. 11. Britton JR , Britton HL , Gronwaldt V. Early perinatal hospital discharge and parenting during infancy. Pediatrics 1999; 104: 1070- 6.
Malkin JD, Garber S, Broder MS, et al. Infant mortality and early postpartum discharge. Obs and Gynecology 2000; 96: 183- 8.
Maisels MJ, Kring E. Length of stay, jaundice and hospital readmission. Pediatrics 1998; 101: 995- 8.
Conclusıons: The rehospitalization rate in our unit was 15% while it was 3.8% among newborns in the study group. The most frequent
rehospitalization indication was hyperbilirubinemia followed by hypernatremic dehydration as the second. Mortality rate was high in the ductus
dependent congenital hearth disease (33%) and there were not any case of hyperphenylalaninemia missed for diagnosis. Centers for Disease Control and Prevention. Trends in length
of stay for hospital deliveries United States. MMWR 1995; 44: 335- 7. 2.
Margolis HM. A critical review of studies of newborn discharge
timing. Clin Pediatr 1995; 34: 626- 34. 3.
Danielsen B , Castles AG, Damberg L, et al. Newborn discharge
timing and readmissions: California 1992-1995. Pediatrics 2000; 106: 31- 9. 4.
American Academy of Pediatrics (AAP) commitee on fetus
and newborn hospital stag for health term newborn. Pediatrics 2004; 113: 1434- 8. 5.
Bhutani V, Johnson L, Sivier E. Predictive ability of a predischarge
hour specific serum bilirubin for subsequent significant hyper
bilirubinemia in healthy term and near- term newborns. Pediatrics 1999; 103: 6- 8. 6.
İra D, Davis D, Ellis D. Avner fluid, electrolytes and acid-base
homeostasis. In: Avroy A, Fanaroff RJ. Martin (eds). Neonatal
Perinatal Medicine Diseases of the fetus and Infant. 7th edition.
St Louis: Mosby, 2002; 625 - 6. 7.
Lubchenco LO: A practical classification for newborn infants
by weight and gestational age. J Pediatr 1967; 7:159- 67. 8.
Lock M , Ray JG. Higher neonatal morbidity after routine
early hospital discharge: are we sending newborns home too
early? CMAJ 1999; 161: 249- 52. 9.
Bragg EJ, Rosenn B, Khoury J, et al. The effect of early discharge
after vaginal delivery on neonatal readmission rates. Obstet
and Gynecol 1997; 89: 930- 3.
Millar KR, Gloor JE, Wellington N, et al. Early neonatal presentations to the pediatric emergency department. Pediatr Emerg Care 2000; 16: 145- 50.
Britton JR , Britton HL , Gronwaldt V. Early perinatal hospital discharge and parenting during infancy. Pediatrics 1999; 104: 1070- 6.
Malkin JD, Garber S, Broder MS, et al. Infant mortality and early postpartum discharge. Obs and Gynecology 2000; 96: 183- 8.
Maisels MJ, Kring E. Length of stay, jaundice and hospital readmission. Pediatrics 1998; 101: 995- 8.
Conclusıons: The rehospitalization rate in our unit was 15% while it was 3.8% among newborns in the study group. The most frequent
rehospitalization indication was hyperbilirubinemia followed by hypernatremic dehydration as the second. Mortality rate was high in the ductus
Millar KR, Gloor JE, Wellington N, et al. Early neonatal presentations to the pediatric emergency department. Pediatr Emerg Care 2000; 16: 145- 50.
Britton JR , Britton HL , Gronwaldt V. Early perinatal hospital discharge and parenting during infancy. Pediatrics 1999; 104: 1070- 6.
Malkin JD, Garber S, Broder MS, et al. Infant mortality and early postpartum discharge. Obs and Gynecology 2000; 96: 183- 8.
Maisels MJ, Kring E. Length of stay, jaundice and hospital readmission. Pediatrics 1998; 101: 995- 8.
AOL news. Kaiser Study Finds. Early hospital discharge of newborn is not linked to infant jaundice. UCSF Date: 21;15: 24 -32.
Kavuncuoğlu S, Akın MA, Aldemir H, ve ark. Bebek dostu hastanede emzirme eğitimi ve anne sütü ile beslenmeye etkisi. Ege Pediatri Bülteni 2005; 12:141- 6.
Kavuncuoğlu S, Demirkol M, Özbek S, ve ark. Newborn metabolic screening program in Bakırkoy Maternity Hospital; results of hyperphenylalaninemia screening in 177 379 liveborn infants. Congress of Neonatal Intensive Care, Venice, 6-9 Novomber 2002 .Abstracts book, 155.
Conclusıons: The rehospitalization rate in our unit was 15% while it was 3.8% among newborns in the study group. The most frequent
rehospitalization indication was hyperbilirubinemia followed by hypernatremic dehydration as the second. Mortality rate was high in the ductus
dependent congenital hearth disease (33%) and there were not any case of hyperphenylalaninemia missed for diagnosis.