Objective American Academy of Pediatrics (AAP) neonatal hyperbilirubinaemia guidelines recommend universal predischarge risk assessment and follow-up at 3–5 days of age (Pediatrics 2004; 114:297). They advise against using sunlight for phototherapy (heliotherapy). AAP and Centers for Disease Control and Prevention parental jaundice education concur. Post-discharge care coordination data are limited in diverse populations, and the extent of heliotherapy use is unknown. Our objective is to assess attendance at a follow-up appointment at 3–5 days of age and recommendations for the use of alternative light therapy.
Methods We prospectively enrolled healthy infants >35 weeks gestation at six sites. Risk factors were assessed through family histories and medical records. Study nurses reinforced standard clinical teaching with verbal and written jaundice education, emphasising timely follow-up. Parents agreed to follow-up at 3–5 days of age. Parents were interviewed 30 days post-delivery and specifically asked if their baby received jaundice treatment other than phototherapy or exchange transfusion.
Results Of 1144 infants, 902 (79%) were seen at 3–5 days. There was no documented follow-up for 241 (21%) infants. Heliotherapy treatment recommendations were reported by 237 (21%), recommended by 66 physicians (19%), 180 nurses (51%), 40 relatives (11%), seven friends (2%), and 57 others (16%).
Conclusions Despite intensive parental jaundice education, 21% did not return at 3–5 days. Despite widely available management guidelines and parent education, heliotherapy was recommended in 21%. Additional strategies are needed to support hospital–community coordinated care and to promote appropriate, safe neonatal jaundice management.
Funding: Supported by HRSA/MCHB U21MC04403; NIH M01RR-00070, M01RR0018; Respironics; TargetHealth.
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