Format

Send to:

Choose Destination
See comment in PubMed Commons below
J Obstet Gynecol Neonatal Nurs. 2006 Jul-Aug;35(4):444-55.

A systems approach for neonatal hyperbilirubinemia in term and near-term newborns.

Author information

  • 1School of Medicine at Stanford University, Stanford, California, and Newborn Pediatrics, Pennsylvania Hospital, Philadelphia 19107, USA.

Abstract

OBJECTIVE:

To propose and implement a family-centered systems approach to manage newborn jaundice for safer outcomes.

DESIGN:

Observational study for known adverse outcomes.

SETTING:

Semiprivate urban birthing hospital.

PATIENTS/PARTICIPANTS:

31,059 well babies discharged as healthy from a cohort of 41,961 live births (1990-2000).

INTERVENTIONS:

Incremental implementation of a systems approach that incorporated a hospital policy to (a) authorize nurses to obtain a bilirubin (total serum/transcutaneous) measurement for clinical jaundice, (b) universal predischarge total serum bilirubin (at routine metabolic screening), and (c) targeted follow-up, using the bilirubin nomogram (hour-specific, percentile-based total serum bilirubin/transcutaneous bilirubin).

MAIN OUTCOME MEASURES:

Known adverse outcomes assessed for early- and late-onset severe hyperbilirubinemia before, during, and after systems approach implementation.

RESULTS:

Adverse outcomes decreased for well babies: exchange transfusion, intensive phototherapy, and readmission. During the study period, there were no "never events" (total serum bilirubin greater than or equal to 30 mg/dl), while "close calls" (total serum bilirubin greater than or equal to 25 mg/dl) were 1 in 15,000 as compared to a reported incidence of 1 in 625.

CONCLUSIONS:

Reduced adverse events, significant reduction in close calls, and no never events met family expectations for safer experiences with this approach.

PMID:
16881988
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Blackwell Publishing
    Loading ...
    Write to the Help Desk