Published online July 27, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 548-554 (doi:10.1542/peds.2008-2926)
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ARTICLE

Delayed Pediatric Office Follow-up of Newborns After Birth Hospitalization

Jochen Profit, MD, MPHa,b,c, Alva J. Cambric-Hargrove, RNd, Kay O. Tittle, RNd, Kenneth Pietz, PhDb,c and Ann R. Stark, MDa

a Section of Neonatology, Department of Pediatrics
b Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
c Houston Veterans Affairs (VA) Health Services Research and Development Center of Excellence, Health Policy and Quality Program, Michael E. DeBakey VA Medical Center, Houston, Texas
d Texas Children's Pediatric Associates Operations, Texas Children's Hospital, Houston, Texas

BACKGROUND: Key recommendations of the American Academy of Pediatrics guideline on management of severe hyperbilirubinemia in healthy infants of ≥35 weeks' gestation include predischarge screening for risk of subsequent hyperbilirubinemia, follow-up at 3 to 5 days of age, and lactation support. Little information is available on contemporary compliance with follow-up recommendations.

OBJECTIVE: To assess timing and content of the first newborn office visit after birth hospitalization in urban and suburban pediatric practices in Houston, Texas.

METHODS: We reviewed office records for the first visit within 4 weeks of birth during January through July 2006 for apparently healthy newborns with a gestational age of ≥35 weeks or birth weight of ≥2500 g seen within a pediatric provider network. For each pediatrician, we selected every fifth patient up to a total of 6.

RESULTS: Of 845 records abstracted, 698 (83%) were eligible for analysis. Infants were seen by 136 pediatricians in 39 practices. They had vaginal (64%) or cesarean (36%) deliveries at 20 local hospitals, of which 17 had routine predischarge bilirubin screening policies. Only 37% of all infants, 44% of vaginally delivered infants, and 41% of exclusively breastfed infants were seen before 6 days of age. Thirty-five percent of the infants were seen after 10 days of age. Among 636 infants seen at ≤15 days, jaundice was noted on examination in 33%; of these, 44% had bilirubin measured. Nine infants had phototherapy documented after birth hospitalization.

CONCLUSIONS: Among a large group of urban and suburban pediatricians, implementation of the American Academy of Pediatrics recommendation for follow-up was inconsistent, and delayed follow-up was common. Understanding reasons for delayed follow-up and providing guidance for jaundice management may promote a safer first week of life.

Key Words: infant • newborn • hyperbilirubinemia • practice guidelines • quality of care

Abbreviations: AAP—American Academy of Pediatrics • GA—gestational age • BW—birth weight

Accepted Jan 30, 2009.


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