Evaluating Nursery Phototherapy Use and Discharge Practices After the Creation of a Weekend Newborn Clinic
| Autor: | Rosa St. Angelo, David Drachman, Amy Guzek, Vasudha Bhavaraju |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Pediatrics
medicine.medical_specialty Outpatient Clinics Hospital Bilirubin Specific risk 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine 030225 pediatrics medicine Outpatient clinic Humans 030212 general & internal medicine Referral and Consultation Retrospective Studies business.industry Arizona Infant Newborn Historically Controlled Study Retrospective cohort study General Medicine Guideline Nomogram Jaundice Continuity of Patient Care Phototherapy medicine.disease Patient Discharge Jaundice Neonatal chemistry Pediatrics Perinatology and Child Health Kernicterus medicine.symptom Hyperbilirubinemia Neonatal business Nurseries Infant |
| Zdroj: | Hospital pediatrics. 6(7) |
| ISSN: | 2154-1663 |
| Popis: | Neonatal jaundice has been reported for centuries and remains one of the most common newborn concerns, with nearly two-thirds of infants having jaundice in the first week of life.1 Although most cases of jaundice are nonthreatening, many infants require treatment with phototherapy. Incidences of significantly high levels still remain, placing infants at risk for kernicterus, a rare but often preventable cause of permanent neurologic impairment. Bilirubin levels peak at 3 to 5 days of life, but with early infant discharges and barriers to establishing consistent follow-up care, physicians are challenged to determine which babies will go on to have pathologic jaundice requiring further intervention.2 The American Academy of Pediatrics (AAP) addressed this issue of newborn jaundice in 2004 and updated its stance in 2009, with a clinical practice guideline that recommends all well newborns receive a screening bilirubin level before discharge, with results interpreted using a specific risk nomogram (Fig 1).2,3 On the basis of this algorithm, newborns who have bilirubin levels falling within the high-risk or high/intermediate-risk zones but do not require phototherapy may be discharged. These infants, however, should have a follow-up evaluation within 24 or 48 hours, based on the specific risk zone. This recommendation may be altered depending on the presence of associated risk factors (Fig 2). The guideline further states that if appropriate follow-up cannot be arranged for such babies, for example, because of lack of outpatient clinic hours on weekends and holidays, the discharges should be delayed until their risk factors have diminished. FIGURE 1 Risk designation of term and near-term well newborns based on hour-specific serum bilirubin values; used to interpret discharge bilirubin levels to predict babies at risk for levels that rise above the 95th percentile. (Reproduced with permission from the AAP and Bhutani VK, Johnson L, Sivieri … |
| Databáze: | OpenAIRE |
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