Article Text

UNIVERSAL BILIRUBIN MANAGEMENT CHALLENGES IN A RACIALLY AND ETHNICALLY DIVERSE COHORT OF US NEWBORNS
  1. J Y Hall1,
  2. A R Stark2,
  3. V K Bhutani1,
  4. R L Poland1,
  5. A E Burgos3,
  6. G R Gourley4,5,
  7. L D Meloy6,
  8. A M Enright7
  1. 1Pediatrics, Stanford University, Lucile Packard Children’s Hospital, Stanford, California, USA
  2. 2Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Ben Taub Hospital, Houston, Texas, USA
  3. 3Pediatrics, University of New Mexico, University of New Mexico Hospitals, Albuquerque, New Mexico, USA
  4. 4Pediatrics, University of Minnesota, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
  5. 5Pediatrics, Oregon Health and Sciences University, Doernbecher Children’s Hospital, Portland, Oregon, USA
  6. 6Pediatrics, Virginia Commonwealth University, Medical College of Virginia Children’s Pavilion, Richmond, Virginia, USA
  7. 7Pediatrics, Palo Alto Medical Foundation, Lucile Packard Children’s Hospital, Palo Alto, California, USA

Abstract

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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