Effect of publication of the “Practice Parameter for the Management of Hyperbilirubinemia” on treatment of neonatal jaundice

Seidman, Daniel S.; Paz, Ido; Armon, Yaacov; Ergaz, Zivanit; Stevenson, David K.; Gale, Rena

doi:10.1111/j.1651-2227.2001.tb00307.x

Cited by 21 publications

(8 citation statements)

References 13 publications

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“…Increased treatment in preterm infants may simply be a spillover effect from the focus on term infants in the 1994 guideline. 10,42 Alternatively, the finding in preterm newborns could be a consequence of the multi-factorial nature of changes in management practice. It is likely that clinical practice changed before the published guideline.…”

Section: Discussionmentioning

confidence: 92%

“…Only 1 study examined changes in the management of jaundice in relation to the 1994 AAP guideline and found that both phototherapy and exchange transfusion rates declined in 2 community hospitals in Jerusalem. 10 The 1994 guideline and the subsequent 2004 revision raised a number of concerns. The 1994 guideline embraced a "kinder and gentler" approach to the management of jaundice in neonates.…”

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confidence: 99%

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Trends in Hospitalizations for Neonatal Jaundice and Kernicterus in the United States, 1988–2005

et al. 2009

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Nationally representative hospital data indicate a declining incidence of hospitalizations with a diagnosis of kernicterus in newborn infants over the period 1988-2005. The decline occurred before and immediately after publication of the 1994 American Academy of Pediatrics guideline on hyperbilirubinemia. Epidemiologic findings were mostly consistent with other studies. Healthcare Cost and Utilization Project data provide an important system for monitoring hospitalizations of uncommon newborn conditions such as kernicterus.

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Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 99%

Trends in Hospitalizations for Neonatal Jaundice and Kernicterus in the United States, 1988–2005

et al. 2009

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“…15 Studies also showed a decrease in the use of phototherapy and exchange transfusion after the publication of the guideline. 16 This more relaxed approach to jaundice converged with 2 other trends: a push toward early postnatal discharge of term and late preterm infants and initiatives to promote breastfeeding. Our population-based data suggest that these 3 factors had a synergistic effect, ultimately resulting in an overall increase in readmissions for jaundice.…”

Section: Discussionmentioning

confidence: 96%

Readmission for Neonatal Jaundice in California, 1991–2000: Trends and Implications

Burgos¹,

Schmitt

Stevenson³

et al. 2008

Pediatrics

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Risk-adjusted readmission rates for jaundice rose following the 1994 hyperbilirubinemia guidelines and declined after postpartum length-of-stay legislation in 1998. In 2000, the readmission rate remained 6% higher than in 1991. These findings highlight the complex relationship among newborn physiology, socioeconomics, race or ethnicity, public policy, clinical guidelines, and physician practice. These trend data provide the necessary baseline to study whether revised guidelines will change practice patterns or improve outcomes. Cost data also provide a break-even point for prevention strategies.

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“…After publishing practical guidelines for the management of hyperbilirubinaemia in healthy term newborns 17, a decrease in PT use has been observed 18. Some authors have discussed this development.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of umbilical cord blood bilirubin for postnatal hyperbilirubinaemia

et al. 2005

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Aim: The study investigated the predictive value of umbilical cord serum (UCS) bilirubin for the postnatal course of bilirubinaemia in healthy term and near‐term newborns. Methods: Term appropriate‐for‐gestational‐age (AGA; n=1100), small‐for‐gestational‐age (SGA; n=163) and near‐term infants (GA 34–36 wk; n=78) were included and separated according to their UCS bilirubin levels, starting from <20 (group 1), 20–<30 (2), 30–40 (3) and >40 (4) μmol/l. The newborns were followed for at least 5 postnatal days, and UCS bilirubin values were correlated with the development of hyperbilirubinaemia and phototherapy (PT) treatment. Results: A clear relation between UCS bilirubin and the development of hyperbilirubinaemia was found in all three patient populations. None of the 75 AGA patients of group 1 developed postnatal bilirubin values above 300 μmol/l, whereas 0.3, 3.4 and 8.6% of the patients in groups 2–4, respectively, did so. The frequency of PT increased from 0% in group 1 up to 9.6% in group 4. For the prediction of further need of PT using a UCS bilirubin cut‐off level of 30 μmol/l, we found a sensitivity of 90% and a negative predictive value of 99.1%, indicating that all patients with UCS bilirubin values below 30 μmol/l (443/1100 or 40.2%) were at a very low risk of developing dangerous hyperbilirubinaemia. Similar results were obtained in SGA children with a sensitivity of 94.1% and a negative predictive value of 98.6%. In comparison to term newborns, we generally found higher bilirubin values in preterms. A total of 6.4% of preterm children developed bilirubin values over 300 μmol/l, compared with 3% of term children, and 47.4% of preterms had to be treated with PT. Predicting the need of PT by using a UCS bilirubin cut‐off level of 30 μmol/l revealed a sensitivity of 70.3% and a negative predictive value of 65.6%. Conclusion: These data suggest that UCS bilirubin is useful in predicting the postnatal bilirubin values in term and near‐term newborns. We presume that the use of UCS bilirubin values may help detect infants at low risk for postnatal hyperbilirubinaemia and minimize an unnecessary prolongation of hospitalization.

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Effect of publication of the “Practice Parameter for the Management of Hyperbilirubinemia” on treatment of neonatal jaundice

Cited by 21 publications

References 13 publications

Trends in Hospitalizations for Neonatal Jaundice and Kernicterus in the United States, 1988–2005

Trends in Hospitalizations for Neonatal Jaundice and Kernicterus in the United States, 1988–2005

Readmission for Neonatal Jaundice in California, 1991–2000: Trends and Implications

Predictive value of umbilical cord blood bilirubin for postnatal hyperbilirubinaemia

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