RT Journal Article
SR Electronic
T1 Impact of a Transcutaneous Bilirubinometry Program on Resource Utilization and Severe Hyperbilirubinemia
JF Pediatrics
JO Pediatrics
FD American Academy of Pediatrics
SP 77
OP 86
DO 10.1542/peds.2011-0599
VO 129
IS 1
A1 Wainer, Stephen
A1 Parmar, Seema M.
A1 Allegro, Donna
A1 Rabi, Yacov
A1 Lyon, Martha E.
YR 2012
UL http://pediatrics.aappublications.org/content/129/1/77.abstract
AB Objectives: Our goal was to assess the impact of programmatic and coordinated use of transcutaneous bilirubinometry (TcB) on the incidence of severe neonatal hyperbilirubinemia and measures of laboratory, hospital, and nursing resource utilization.Methods: We compared the neonatal hyperbilirubinemia-related outcomes of 14 796 prospectively enrolled healthy infants ≥35 weeks gestation offered routine TcB measurements in both hospital and community settings by using locally validated nomograms relative to a historical cohort of 14 112 infants assessed by visual inspection alone.Results: There was a 54.9% reduction (odds ratio [OR]: 2.219 [95% confidence interval (CI): 1.543–3.193]; P &lt; .0001) in the incidence of severe total serum bilirubin values (≥342 µmol/L; ≥20 mg/dL) after implementation of routine TcB measurements. TcB implementation was associated with reductions in the overall incidence of total serum bilirubin draws (134.4 vs 103.6 draws per 1000 live births, OR: 1.332 [95% CI: 1.226–1.446]; P &lt; .0001) and overall phototherapy rate (5.27% vs 4.30%, OR: 1.241 [95% CI: 1.122–1.374]; P &lt; .0001), a reduced age at readmission for phototherapy (104.3 ± 52.1 vs 88.9 ± 70.5 hours, P &lt; .005), and duration of phototherapy readmission (24.8 ± 13.6 vs 23.2 ± 9.8 hours, P &lt; .05). There were earlier (P &lt; .01) and more frequent contacts with public health nurses (1.33 vs 1.66, P &lt; .01) after introduction of the TcB program.Conclusions: Integration of routine hospital and community TcB screening within a comprehensive public health nurse newborn follow-up program is associated with significant improvements in resource utilization and patient safety.Abbreviations:AAP — American Academy of PediatricsCHR — Calgary Health RegionCI — confidence intervalCLS — Calgary Laboratory ServicesDAT — direct anti-globulinNH — neonatal hyperbilirubinemiaOR — odds ratioPHN — public health nursePTU — phototherapy unitTcB — transcutaneous bilirubinometryTSB — total serum bilirubin