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Published on: December 31, 2015
Implementation of a neonatal transcutaneous bilirubin screening programme in rural India
Melissa C Morgan1, G S Kumar2, Sunitha V Kaiser1
1a Department of Paediatrics , University of California , San Francisco , USA.
Insights
Universal transcutaneous bilirubin (TcB) screening is feasible and acceptable in rural India, identifying high-risk infants when follow-up is uncertain. This method aids in managing neonatal hyperbilirubinaemia in resource-limited settings.
Area of Science:
- Neonatal care
- Public health
- Medical technology
Background:
- Neonatal hyperbilirubinaemia requires universal pre-discharge risk assessment.
- Transcutaneous bilirubin (TcB) screening is a common method, but its feasibility in low-income settings is understudied.
- Early identification of jaundice is crucial for preventing severe outcomes.
Purpose of the Study:
- To assess the acceptability and feasibility of universal TcB screening in a resource-limited rural Indian hospital.
- To determine if TcB screening increased the recognition of high-risk neonatal hyperbilirubinaemia.
- To evaluate the implementation of a jaundice screening protocol in a low-resource environment.
Main Methods:
- Universal TcB screening was implemented at 24-48 hours of life in rural India.
- Total serum bilirubin (TSB) was measured for infants with concerning TcB results.
- Rates of consent, TcB/TSB testing, phototherapy, and high-risk hyperbilirubinaemia were compared pre- and post-implementation.
Main Results:
- 86% of eligible families consented to TcB screening.
- TcB screening was successfully implemented with high participation.
- The rates of TSB testing and phototherapy remained similar, but five cases of high-risk hyperbilirubinaemia were identified post-implementation.
Conclusions:
- Universal TcB screening is acceptable and feasible in resource-limited settings.
- TcB screening can effectively identify infants needing further evaluation for hyperbilirubinaemia when early follow-up is challenging.
- This approach supports proactive jaundice management in underserved areas.
Background:
Universal pre-discharge assessment of risk for neonatal hyperbilirubinaemia is recommended by the American Academy of Pediatrics. A common algorithm is universal transcutaneous bilirubin (TcB) screening, followed by confirmatory total serum bilirubin (TSB) testing for results which cause concern. There is a paucity of data on the feasibility of TcB screening in low-income settings.
Objectives:
To evaluate the acceptability and feasibility of implementing universal TcB screening at a resource-limited hospital in rural India, and to determine if it was associated with increased recognition of high-risk hyperbilirubinaemia.
Methods:
In December 2012 at Vivekananda Memorial Hospital, Karnataka, India, universal TcB screening at 24-48 hours of life was implemented, with TSB estimated if TcB was >75th percentile for age. The proportion of families that provided consent and the proportion of infants who underwent TcB and TSB testing were calculated. The rates of phototherapy pre- and post-implementation and the rate of high-risk hyperbilirubinaemia (TSB >95th percentile for age) post-implementation among infants ≥ 35 weeks gestation were determined.
Results:
Parents of 568 of 660 (86%) eligible infants consented to participation. All of these infants were screened with TcB. The proportion who had TSB testing was similar in the pre- (6%) and post-implementation (7%) periods. The rate of phototherapy was not significantly different after implementation (2% vs 3%). Five cases of high-risk hyperbilirubinaemia were identified post-implementation.
Conclusions:
The study demonstrates the acceptability and feasibility of universal TcB screening at a resource-limited hospital in rural India. In settings in which early post-discharge follow-up cannot be assured, TcB can play a valuable role in identifying infants who need evaluation.
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