1 Department of Pediatrics, Newborn Service, Kaiser Foundation Hospital & Southern California Permanente Medical Group, 13652 Cantara St. Panorama City, California
The problem of jaundice is frequent in a large nursery service. In a hospital delivering 400 to 500 babies per month, our "exchange team" commonly sees 15 to 20 babies each month. Most of these are subjected to diagnostic hematologic and bilirubin studies; some require exchange transfusion. We have devised the forms reprinted herein to be used as part of the newborn infant's record.
The "Graphic Data SheetNewborn Jaundice" (Fig. 1) has been useful in the following way. 1. All laboratory work is recorded on this form. 2. An over-all numerical record of the rate of rise and the degree of bilirubinemia is immediately apparent. 3. The need to search through many laboratory slips to relate age to level of bilirubin is avoided. 4. After discharge this sheet is removed and kept for future evaluation of our experience with neonatal jaundice in regard to etiology, frequency, course, and management. 5. We have also used this record for newborn infants with mild clinical icterus, if any work-up is done, to give more accuracy to statistical studies.
The "Exchange Transfusion RecordNewborn Jaundice" (Fig. 2) is used for all exchange transfusions of newborn infants. All occurrences and medications during exchange are recorded. Changes in the infant's condition, venous pressure, pulse rate, calcium infusions, exchange volume, and duration for procedure are documented. Morbidity and mortality statistics on exchange transfusions may then be readily accumulated.
These records and their analyses have facilitated our management of hyperbilirubinemia from known hemolytic disease, as well as bilirubinemia of undiscovered origin (called B.U.O. in our nursery). Perhaps other pediatricians would find these forms an aid to their care and study of newborn infants with jaundice.
We have submitted these records to the Academy's Committee on Fetus and Newborn for consideration as part of the "Standards and Recommendations for Hospital Care of Newborn Infants."