Evaluation and management of newborn jaundice by midwest family physicians

Recognition and management of newborn jaundice is controversial and even more challenging with the early discharge of newborns. The purpose of this study was to describe the jaundice management patterns of family physicians in Minnesota and Wisconsin and compare them with American Academy of Pediatrics recommendations.

Forty-two members of the Practice-Based Research Group of the Wisconsin Research Network and of the Minnesota Academy of Family Physicians Research Network recorded information on study cards about the care they provided to healthy full-term newborns for 6 months.

Data was collected on 335 infants, 30% of whom were jaundiced. Physicians ordered limited laboratory testing on selected jaundiced infants. Infants with jaundice were more frequently breast-fed, and had longer hospital stays. Jaundice was commonly managed by phototherapy (17%), home sunlight (28%), and increased breast-feeding (44%). Twenty-six percent of the physicians used a formal phototherapy guideline. The timing of the first follow-up visit did not differ for infants discharged before or after 48 hours of age.

Family physicians identified and managed newborn jaundice relatively infrequently in our study. Their practice patterns were consistent with most aspects of the American Academy of Pediatrics jaundice guideline, although few of them used it to guide phototherapy use. The study physicians did not generally follow recommendations for follow-up of infants discharged early. Until a large-scale clinical trial of newborn jaundice management is performed, a variety of practices should continue to be acceptable.