Effect of Instituting a Hospital Pre-discharge Bilirubin Screening on Subsequent Significant Hyperbilirubinemia in Term and Near Term Newborn

Abstract

Background: Neonatal Jaundice is a common disorder worldwide. Early identification and proper management is needed to prevent the serious neurological complications associated with it. Objective: The aim of this study is to assess the predictive ability of a pre-discharge serum bilirubin measurement to screen for subsequent significant hyperbilirubinemia in the term and near-term newborn. Materials and Methods: This is a historic cohort study conducted at Makassed General Hospital during two periods of time: January 2011 till December 2011, versus January 2013 till December 2013. A bilirubin screening program, instituted in February 2012, called for a total serum bilirubin to be performed on every neonate before discharge regardless of whether clinical jaundice was observed. For non-jaundiced neonates, the nursery staff was encouraged to obtain the screening total serum bilirubin at the sametime they obtained the hospital-mandated newborn screen for inborn errors of metabolism. Bilirubin values were plotted on an hour-specific nomogram. This study compared mean total serum bilirubin and hospital readmission data for two different periods before and after implementing the program. Results: The study involved 1200 neonates: 601 in period one and 599 in period two. After initiating the program, the mean peak of total serum bilirubin fell from 14.76 mg/dl to 11.03 mg/dl. Also the rate of hospital readmission with a primary diagnosis of jaundice fell from 10% in period one to 1.8% in period two. Conclusion: A pre-discharge total serum bilirubin applied as a policy in hospitals would facilitate targeted intervention and follow-up for indirect hyperbilirubinemiaina safe, cost-effective manner.