Quality improvement initiative using transcutaneous bilirubin nomogram to decrease serum bilirubin sampling in...

Area of Science:

• Neonatal care
• Pediatric diagnostics
• Medical technology innovation

Background:

• Traditional neonatal hyperbilirubinaemia screening relies on serum bilirubin sampling.
• Serum sampling presents drawbacks including infection risk and delayed results.
• There is a need for more efficient and safer screening methods.

Purpose of the Study:

• To evaluate the impact of implementing transcutaneous bilirubin (TcBR) testing with a TcBR nomogram.
• To assess the reduction in serum bilirubin samples following TcBR introduction.
• To analyze cost-effectiveness of the new screening protocol.

Main Methods:

• A before-and-after study design was employed.
• The Dragger JM-105 transcutaneous bilirubinometer was integrated into postnatal ward protocols.
• Serum bilirubin sample rates were compared pre- and post-implementation over 12 months for eligible neonates (≥37 weeks gestation, ≥2500g, jaundice after 24 hours).

Main Results:

• The proportion of neonates with serum bilirubin samples decreased from 49% (pre-implementation) to 17% (post-implementation).
• Odds of requiring serum bilirubin testing were reduced by 79% post-implementation (OR 0.21).
• An estimated cost saving of approximately US$1800 was achieved over a 6-month period.

Conclusions:

• Transcutaneous bilirubin testing, combined with a nomogram, substantially decreases the necessity for serum bilirubin sampling.
• This approach offers a more efficient and potentially cost-saving method for neonatal jaundice screening.
• The findings support the integration of TcBR testing into routine neonatal care pathways.