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Post-discharge neonatal hyperbilirubinemia surveillance
Michael Kaplan1,2, Deena Zimmerman1,2, Hanna Shoob1
1Jerusalem District Health Office, Israel Ministry of Health, Jerusalem, Israel.
Insights
Community jaundice assessment in newborns is low, especially for low-risk infants. Specific instructions for bilirubin testing improved compliance, highlighting the need for better discharge guidelines.
Area of Science:
- Neonatal care
- Public health surveillance
- Jaundice management
Background:
- The Israel Neonatal Society established guidelines in 2008 for universal community assessment of jaundice within 72 hours of discharge.
- Effective implementation of these guidelines is crucial for early detection and management of neonatal hyperbilirubinemia.
Purpose of the Study:
- To assess the implementation of the 2008 Israel Neonatal Society guidelines for community jaundice assessment within 72 hours of hospital discharge.
- To evaluate the rate of early follow-up examinations for jaundice in newborns.
Main Methods:
- Mothers of newborns in the Jerusalem District were interviewed regarding jaundice evaluations.
- Newborn hospital discharge letters were reviewed for appropriate instructions on early jaundice follow-up.
Main Results:
- Only 32.9% of low-risk newborns were examined for jaundice within 72 hours of discharge; 8.3% were referred for testing.
- Nearly all high-risk newborns (99.1%) complied with specific instructions for a bilirubin test the day after discharge.
- Only 46.2% of discharge letters included specific instructions for 72-hour follow-up for jaundice.
Conclusions:
- The rate of community surveillance for newborn jaundice is low, indicating suboptimal guideline implementation.
- Targeted instructions for bilirubin testing significantly improve compliance.
- Inconsistent and inadequate written instructions in hospital discharge summaries may hinder effective jaundice surveillance.
Aim:
To assess implementation of the Israel Neonatal Society's 2008 guidelines for universal community assessment of jaundice within 72 hours of discharge from birth hospitalisation.
Methods:
Mothers of newborns were interviewed at Maternal Child Health Clinics in the Jerusalem District, Israel, and asked whether their newborn had been evaluated for jaundice within the recommended time frame. Newborn discharge letters from Israeli hospitals were assessed for appropriate inclusion of instructions for early follow-up for jaundice.
Results:
Out of 659, 217 (32.9%) mothers whose newborns were at low risk for neonatal hyperbilirubinemia reported an examination within 72 hours of discharge. Eighteen (8.3%) were referred for a bilirubin test. In contrast, 99.1% (109/110) of high-risk newborns who were specifically invited for a bilirubin test the day following discharge complied. Out of 26, 12 (46.2%) hospital discharge letters specified both a time limit of 72 hours post-discharge and jaundice as a reason for early follow-up.
Conclusion:
The early community surveillance rate for jaundice was low, contrasting with near universal compliance in those who received a specific instruction for a post-discharge bilirubin blood test. Inclusion of specific written instructions in hospital discharge summaries was also low and may contribute to poor implementation of guidelines.
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