FIGURE
New Hyperbilirubinemia Measuring Tool Chou S, Palmer RH, Ezhuthachan S, et al: Management of Hyperbilirubinemia in Newborns: Measuring Performance by Using a Benchmarking Model. Pediatrics 2003; 112(6):1264-1273.
Phototherapy and exchange transfusion have greatly reduced the incidence of kernicterus; however, early hospital discharge, breast-feeding with inadequate monitoring for adequate intake, and lack of prompt treatment with phototherapy may be reversing this trend. Neonatal jaundice is common in 60% of term newborns in the first week of life. Over 2% of the infants have total serum bilirubin levels that reach 20 mg/dL, requiring intensive therapy. This article introduces a system called Bilirubin Management Guidelines for Healthy Term Infants, which uses a benchmarking model to evaluate hyperbilirubinemia and suggests standards for management. Over a 3-year period, the Henry Ford Health System monitored more than 5,000 healthy newborns to develop a graph comparing total bilirubin (in mg per 100 ml) to 30 mg, and the age of the child to 7 days (168 hours). The graph is laminated into a colorful pocket card displaying areas of physiologic jaundice, breast-feeding, follow-up, phototherapy, and when to start intensive phototherapy.
The reverse of the card lists monitoring and discharge planning, home care nurse follow-up, and phototherapy indications. The authors suggest other hospitals might use these guidelines as a benchmark of their management of hyperbilirubinemia.