July 27, 2009

Following Guidelines Can Improve Care For Newborn Jaundice

Following American Academy of Pediatrics (www.aap.org) guidelines for monitoring and diagnosing newborn jaundice or hyperbilirubinemia can result in better treatment and fewer cases of kernicterus, a form of brain damage caused by excessive jaundice, said a health services researcher at Baylor College of Medicine (www.bcm.edu) in a report that appears in the current issue of Pediatrics.

"Little is known about how well pediatricians follow these guidelines," said the study's lead author Dr. Jochen Profit, an assistant professor of pediatrics"”neonatology and of medicine"”health services research at BCM. "We hope this study will help educate pediatricians around the country about the importance of early follow-up care and support for newborns."

In cooperation with clinicians from BCM, Texas Children's Hospital (www.texaschildrens.org), and others, the American Academy of Pediatrics has developed an on-line toolkit (http://www.aap.org/qualityimprovement/quiin/SHB.html) to help educate pediatricians on assessing the risk for hyperbilirubinemia, on supporting breastfeeding mothers and coordinating care between the hospital nursery and the pediatrician's office.

The Academy guidelines advise:

-Predischarge risk assessment for subsequent severe hyperbilirubinemia (measurement of the bilirubin level and/or assessment of clinical risk factors.)

-Follow-up at three to five days of age.

-Breastfeeding support.

Hyperbilirubinemia occurs when there are high levels of a substance known as bilirubin in the blood. Bilirubin is formed when the body breaks down old red blood cells, causing yellowing of the skin (known as jaundice). In newborns bilirubin levels rise over the first few days and usually peak by three to seven days of age. Breastfed babies tend to have higher levels of bilirubin and for a longer time.  

In some infants, bilirubin can build up to dangerous levels. If dangerous levels are detected, treatment can reduce the bilirubin level in the newborn's blood.

However, if missed or left untreated, high levels of bilirubin may cause kernicterus, a form of permanent brain damage.

To assess compliance with the guidelines, Profit and colleagues reviewed the charts of 136 pediatricians to evaluate timing and content of the first newborn office visit.

They found that that only 37 percent of 698 newborns and only 41 percent of exclusively breastfed infants were seen within the recommended first six days.

Profit and his colleagues said the lack of follow-up might occur for several reasons.

Some doctors may be reassured by a predischarge bilirubin level that did not predict high risk for a later high bilirubin level. Others may not be willing to change their practice because they disagree with the guidelines as too stringent, burdensome to families, or not cost-effective.  Furthermore, insurance companies pay doctors very little for early follow-up visits.

"The problem of newborn follow-up care is not new. It is a very complicated process that requires a coordinated effort among patients, hospitals, pediatricians, and health insurers," said Profit. "The American Academy of Pediatrics Safe and Healthy Beginnings Toolkit is an important step to promote a safer first week of life. Health insurers could support this goal by rewarding pediatricians or patients for appropriate newborn follow-up. "   

A link to the study article in Pediatrics can be found at http://pediatrics.aappublications.org/.

Funding for the research came from the National Institutes of Health (www.nih.gov).


On The Net: