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PEDIATRICS Vol. 104 No. 5 Supplement November 1999, pp. 1198-1203

Frequency of Neonatal Bilirubin Testing and Hyperbilirubinemia in a Large Health Maintenance Organization

Received Jun 14, 1999; accepted Aug 15, 1999.

Thomas B. Newman*, Gabriel J. EscobarDagger , Veronica M. GonzalesDagger , Mary Anne ArmstrongDagger , Marla N. GardnerDagger , and Bruce F. FolckDagger

From the * Departments of Epidemiology and Biostatistics, Pediatrics, and Laboratory Medicine, School of Medicine, University of California, San Francisco, California; and the Dagger  Division of Research, Kaiser Permanente Medical Care Program, Oakland, California.

Objective.  To determine the frequency and interhospital variation of bilirubin testing and identified hyperbilirubinemia in a large health maintenance organization.

Design.  Retrospective cohort study.

Setting.  Eleven Northern California Kaiser Permanente hospitals.

Subjects.  A total of 51 387 infants born in 1995-1996 at >= 36 weeks' gestation and >= 2000 g.

Main Outcome Measure.  Bilirubin tests and maximum bilirubin levels recorded in the first month after birth.

Results.  The proportion of infants receiving >= 1 bilirubin test varied across hospitals from 17% to 52%. The frequency of bilirubin levels >= 20 mg/dL (342 µmol/L) varied from .9% to 3.4% (mean: 2.0%), but was not associated with the frequency of bilirubin testing (R2 = .02). Maximum bilirubin levels >= 25 mg/dL (428 µmol/L) were identified in .15% of infants and levels >= 30 mg/dL (513 µmol/L) in .01%.

Conclusions.  Significant interhospital differences exist in bilirubin testing and frequency of identified hyperbilirubinemia. Bilirubin levels >= 20 mg/dL were commonly identified, but levels >= 25 mg/dL were not.  Key words:  jaundice, neonatal-diagnosis, jaundice, neonatal-epidemiology, bilirubin-blood, ethnic groups..




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