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Assessment of adherence level for neonatal hyperbilirubinemia management by various physicians in Iraq: a
Numan Nafie Hameed1,2, Hikmat Noori Yousif2, Hayder Adnan Fawzi3
1Department of Pediatrics, College of Medicine, Baghdad University, Baghdad, 12221, Iraq.
Insights
Pediatricians in Iraq demonstrated higher adherence to neonatal hyperbilirubinemia guidelines than general practitioners and emergency physicians. This highlights a need to improve guideline compliance among non-pediatric specialists for better infant care.
Area of Science:
- Neonatology
- Public Health
- Clinical Practice Guidelines
Background:
- Neonatal jaundice is common but can become pathological, posing risks.
- Effective management of neonatal hyperbilirubinemia is crucial for infant health.
- Adherence to established guidelines is essential for optimal patient outcomes.
Purpose of the Study:
- To evaluate physician adherence to neonatal hyperbilirubinemia management guidelines in Iraq.
- To compare adherence levels among pediatricians, general practitioners, and emergency physicians.
- To identify potential gaps in the implementation of jaundice management protocols.
Main Methods:
- An observational, cross-sectional study conducted in Iraqi outpatient clinics (February 2018-February 2019).
- 130 physicians (pediatricians, general practitioners, emergency physicians) participated.
- Compliance assessed via questionnaire, including a test case scenario for management.
Main Results:
- Pediatricians showed higher adherence (91.7% correct management) than general practitioners (58.9%) and emergency physicians (38.1%).
- Pediatricians were more likely to test bilirubin levels before discharge (91.7%) compared to GPs (5.5%) and EPs (0%).
- Follow-up visit scheduling varied significantly across physician types.
Conclusions:
- General practitioners and emergency physicians exhibit lower adherence to neonatal jaundice management guidelines compared to pediatricians.
- Physician adherence aligns with World Health Organization (WHO), American Academy of Pediatrics (AAP), and NICE guidelines.
- Enhancing guideline implementation among non-pediatric specialists is recommended.
Abstract:
Background: Neonatal jaundice is a physiological process that occurs normally for every infant to a varying degree. In some cases, this process becomes pathological and imposes an increased risk of morbidity and mortality for the infant. The aim of this study was to assess the adherence level of various physicians to different guidelines of management of neonatal hyperbilirubinemia in Iraq. Methods: An observational cross-sectional study was conducted in multiple outpatient clinics in various Iraqi provinces, from February 2018 to February 2019. The study involved 130 physicians, who were divided into emergency physicians (EPs), general practitioners (GPs), and pediatricians (PDs), and assessed their compliance to guidelines for management of neonatal hyperbilirubinemia using a questionnaire, which included providing the correct management for a test case scenario. Results: PDs had significantly longer discharge times compared to EPs and GPs. In total, 91.7% of PDs always tested the neonate for bilirubin levels before discharge, while 5.5% of GPs and 0% of EP did so. Regarding follow-up visits, 16.7%, 4.8% and 45.2% of PDs, EPs and GPs, respectively, scheduled a follow-up between 49-72 hours; 47.6% and 38.1% of EPs scheduled a follow-up at ≤24 hours and 25-48 hours, respectively. In addition, 91.7% of PDs gave the correct answer for the management of the test case scenario, followed by 58.9% of GPs, and 38.1% of EPs. About half of PDs extended neonates length of stay beyond 48 hours. Conclusion: GPs and EPs show lower adherence levels for the management of neonatal jaundice than PDs, which indicates that these physicians adhere well to current management guidelines from the WHO, AAP, and NICE.
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