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Laboratory evaluation of jaundice in newborns. Frequency, cost, and yield
T B Newman1, M J Easterling, E S Goldman
1Department of Pediatrics, University of California, San Francisco 94143.
Insights
Routine laboratory tests for neonatal hyperbilirubinemia are expensive and rarely identify causes beyond ABO or Rh isoimmunization. Reevaluating the necessity of these common tests is recommended for cost-effectiveness and improved diagnostic yield.
Area of Science:
- Neonatal Medicine
- Pediatric Laboratory Medicine
- Clinical Chemistry
Background:
- Neonatal hyperbilirubinemia is a common condition requiring laboratory evaluation.
- The diagnostic yield and cost-effectiveness of routine hyperbilirubinemia workups are not well-established.
Purpose of the Study:
- To assess the frequency, cost, and diagnostic yield of laboratory tests used for nonphysiologic hyperbilirubinemia in neonates.
- To evaluate the necessity of routine investigations for neonatal jaundice.
Main Methods:
- Retrospective analysis of computerized databases and medical records.
- Inclusion of 2443 infants born between 1980-1982 at the University of California, San Francisco.
- Review of hospital discharge diagnoses for 447 infants meeting criteria for nonphysiologic hyperbilirubinemia.
Main Results:
- 18% of infants had nonphysiologic hyperbilirubinemia, with incidence varying by race (9% Black, 31% Asian).
- 55% of affected infants underwent a $125 workup, but no cause was identified in 48% and a cause was apparent from initial assessment in 32%.
- Only 17% of cases led to a diagnosis of ABO or Rh isoimmunization through routine testing.
Conclusions:
- Nonphysiologic hyperbilirubinemia may be more prevalent than previously thought.
- Current routine laboratory investigations for neonatal hyperbilirubinemia are costly and yield limited diagnoses.
- The routine use of these expensive tests should be reevaluated to improve efficiency and cost-effectiveness.
Abstract:
Neonates with hyperbilirubinemia commonly undergo a battery of laboratory tests. We used a computerized database and medical records to study the frequency, cost, and yield of these tests in 2443 infants born at the University of California, San Francisco, between 1980 and 1982. Four hundred forty-seven (18%) of the infants met standard criteria for "nonphysiologic" hyperbilirubinemia; the incidence varied from 9% in blacks to 31% in Asian infants. About 55% of these 447 infants received a $125 "hyperbilirubinemia workup." Hospital discharge diagnoses on all 447 hyperbilirubinemic infants were reviewed. In 214 (48%), no cause of the jaundice was identified. An additional 145 (32%) had a possible cause apparent from history, physical examination, or initial hematocrit determination. The only diagnosis made as a result of routine investigations of hyperbilirubinemia was possible ABO or Rh isoimmunization in 75 infants (17%). Nonphysiologic hyperbilirubinemia may be more common than previously reported. The recommended tests are expensive and rarely lead to diagnoses other than ABO or Rh isoimmunization. Their routine use should be reevaluated.