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Published on: August 24, 2011
Frequency of neonatal bilirubin testing and hyperbilirubinemia in a large health maintenance organization
T B Newman1, G J Escobar, V M Gonzales
1Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California 94143, USA. newman@itsa.ucsf.edu
Insights
Bilirubin testing and hyperbilirubinemia identification varied significantly between hospitals. While high bilirubin levels were common, severe levels above 25 mg/dL were rare in newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Healthcare
- Clinical Chemistry
Background:
- Hyperbilirubinemia is a common condition in newborns, requiring careful monitoring.
- Variations in clinical practice can impact the diagnosis and management of neonatal jaundice.
Purpose of the Study:
- To assess the frequency of bilirubin testing in infants.
- To determine interhospital variations in identifying hyperbilirubinemia.
- To analyze the occurrence of elevated bilirubin levels across different healthcare settings.
Main Methods:
- Retrospective cohort study of 51,387 infants born between 1995-1996 at >= 36 weeks' gestation and >= 2000 g.
- Data collected from eleven Northern California Kaiser Permanente hospitals.
- Analysis of bilirubin tests and maximum recorded bilirubin levels within the first month of life.
Main Results:
- The proportion of infants tested for bilirubin varied widely (17% to 52%) across hospitals.
- Frequency of bilirubin levels >= 20 mg/dL ranged from 0.9% to 3.4% (mean 2.0%), unrelated to testing frequency.
- Maximum bilirubin levels >= 25 mg/dL occurred in 0.15% of infants, and >= 30 mg/dL in 0.01%.
Conclusions:
- Significant interhospital disparities exist in bilirubin testing practices and hyperbilirubinemia detection.
- Bilirubin levels >= 20 mg/dL were frequently observed, but levels >= 25 mg/dL were uncommon.
- The findings highlight the need for standardized approaches to neonatal jaundice management.
Objective:
To determine the frequency and interhospital variation of bilirubin testing and identified hyperbilirubinemia in a large health maintenance organization.
Design:
Retrospective cohort study.
Setting:
Eleven Northern California Kaiser Permanente hospitals.
Subjects:
A total of 51,387 infants born in 1995-1996 at >/= 36 weeks' gestation and >/= 2000 g.
Main Outcome Measure:
Bilirubin tests and maximum bilirubin levels recorded in the first month after birth.
Results:
The proportion of infants receiving >/= 1 bilirubin test varied across hospitals from 17% to 52%. The frequency of bilirubin levels >/= 20 mg/dL (342 micromol/L) varied from .9% to 3.4% (mean: 2.0%), but was not associated with the frequency of bilirubin testing (R(2) = .02). Maximum bilirubin levels >/= 25 mg/dL (428 micromol/L) were identified in.15% of infants and levels >/= 30 mg/dL (513 micromol/L) in .01%.
Conclusions:
Significant interhospital differences exist in bilirubin testing and frequency of identified hyperbilirubinemia. Bilirubin levels >/=20 mg/dL were commonly identified, but levels >/= 25 mg/dL were not.
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