Quality improvement initiative using transcutaneous bilirubin nomogram to decrease serum bilirubin sampling in low-risk babies

Abstract

BackgroundScreening for neonatal hyperbilirubinaemia in the postnatal ward has traditionally been performed using serum bilirubin sampling, but this has significant drawbacks such as risk of infection and slower reporting time.ObjectiveWe aimed to assess the impact of introducing transcutaneous bilirubin (TcBR) testing using TcBR nomogram on the number of serum bilirubin samples sent.MethodsA before-and-after study was performed following the introduction of a protocol integrating the use of the Dragger JM-105 transcutaneous bilirubinometer in the postnatal ward. Only babies born at ≥37 weeks of gestation, weighing ≥2500 g who presented with jaundice after the first 24 hours and within the first 7 days of life were included in the study. The number of total serum bilirubin samples (TSBRs) sent were compared for the 6-month periods before and after (a total of 12 months) implementation of the new protocol.ResultsIn the pre-implementation phase, a total of 882 (49%) out of 1815 babies had at least one serum bilirubin sample taken as opposed to a total of 236 (17%) out of 1394 babies in the post-implementation phase. The odds of performing TSBRs at least one time among babies in post-implementation phase were 79% lower than in pre-implementation phase (OR 0.21, 95% CI 0.18 to 0.25). We also estimated a significant cost saving of approximately US$1800 over a period of 6 monthsConclusionTcBR testing used in conjunction with our proposed nomogram significantly reduces the need for serum bilirubin sampling.

Management of neonatal jaundice in low- and lower-middle-income countries

“…In the Pakistani study it would have been informative to have other indicators evaluated as well to determine added value and/or safety aspects, such as changes in exchange transfusions, duration of phototherapy, or duration of hospital admission. The mean TSB peak was relatively low in this study population, 9.2 mg/dL before and 10.2 mg/dL after TcB implementation 5. Most likely these low-risk infants are not representative of the large proportion of infants with severe hyperbilirubinemia admitted to non-private, non-tertiary care hospitals in Pakistan.…”

“…Shah et al have evaluated a care improvement initiative in a large hospital in Karachi, the largest city in Pakistan 5. TcB screening of visibly jaundiced, otherwise well babies was implemented and clinical characteristics and jaundice-related outcomes were compared in the 6 months before vs 6 months after implementation.…”

Aplicación del bilirrubinómetro no invasivo en recién nacidos

“…Estos cuestionamientos se plantean a menudo en países en vías de desarrollo. Sin embargo se ha reportado que la implementación de la medición de la BTc antes del alta en Pakistan redujo en un 79% las mediciones séricas de bilirrubina y un (23) ahorro de US $1800 en un periodo de 6 meses .…”

Drive‐through transcutaneous bilirubin screening for neonatal jaundice: A safe and efficient system during the COVID‐19 pandemic

“…This approach requires the physical presence of both parents and their newborns in the primary health‐care clinics, causing crowding and increasing the risk of COVID‐19 infections. Apart from the risk of infection, SB sampling also induces pain in the neonate and increases costs for the laboratory 3 …”