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Outcome analysis of jaundice fast-track system implementation in Thammasat University Hospital
Insights
High bilirubin levels in infants require immediate phototherapy to prevent brain damage. Early recognition of risk factors for exchange transfusion is crucial for effective neonatal jaundice management.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
- Public Health
Background:
- Severe neonatal hyperbilirubinemia poses a risk of acute and chronic bilirubin encephalopathy.
- Infants readmitted with bilirubin levels exceeding 20 mg/dl necessitate emergency medical intervention.
Purpose of the Study:
- To identify causes of severe neonatal hyperbilirubinemia.
- To assess risk factors for exchange transfusion.
- To evaluate outcomes following the implementation of a jaundice fast-track system.
Main Methods:
- Retrospective review of medical records for neonates with significant hyperbilirubinemia.
- Study conducted at Thammasat University from October 2010 to September 2012.
- Inclusion criteria: neonates presenting to outpatient or emergency departments post-fast-track system implementation.
Main Results:
- 76 infants were included; one presented with neurological abnormalities.
- Breastfeeding jaundice was the most common cause (47%).
- Infants with peak bilirubin levels ≥ 24 mg/dl had a significantly higher risk of exchange transfusion (OR = 26.6).
Conclusions:
- Early phototherapy (within one hour of admission) is effective in preventing bilirubin encephalopathy.
- Physician awareness of exchange transfusion risk factors is vital for timely intervention.
- The jaundice fast-track system aims to improve outcomes for neonates with hyperbilirubinemia.
Background:
Infants who were readmitted with high level of bilirubin (more than 20 mg/dl) should be treated as an acute medical emergency to prevent acute and chronic bilirubin encephalopathy.
Objective:
To determine causes of severe neonatal hyperbilirubinemia, risk factors for exchange transfusion and outcomes of neonate after implementation of the jaundice fast-track system in Thammasat hospital.
Material And Method:
The medical records of neonates presenting with clinically significant hyperbilirubinemia to the outpatient department or emergency department after implementation of the jaundice fast-track system at Thammasat university from October 1, 2010 through september 30, 2012, were retrospectively reviewed.
Results:
There were 76 infants included in the study. One infant had neurological abnormalities consistent with acute bilirubin encephalopathy at presentation. all infants received intensive phototherapy. Eight infants (10.5%) underwent an exchange transfusion. a cause of hyperbilirubinemia was identified in 66 cases (86%). Breastfeeding jaundice was the most common cause (47%). The mean peak MB level was higher in the exchange transfusion group than the phototherapy group (25.0 +/- 2.9 mg/dl vs. 21.2 +/- 1.8 mg/dl, p < 0.001). Three infants in the exchange transfusion group had sepsis on admission compared to none in the phototherapy group, (p < 0.001). Infant diagnosed as cephalhematoma underwent an exchange transfusion. The median (range) length of stay was significantly longer in the exchange transfusion group than the phototherapy group (9 (2-15) days vs. 2 (1-12) days, p < 0.001). There were no statistical differences between the two groups in age at readmission and time to phototherapy. All infants in this study were discharged as no neurological abnormalities. Infants presented with peak MB > or = 24 mg/dl had the greatest risk of exchange transfusion (or = 26.6; 95% ci = 4.6, 153.7).
Conclusion:
Initiating phototherapy within an hour of admission in infants who were readmitted with high levels of bilirubin is effective to prevent bilirubin encephalopathy. Physicians' early recognition of the risk factors to exchange transfusion is, therefore, crucial.