Nursing Research Today is a free monthly online journal that collates and summarizes the latest research about Nursing, including details on health care, hospital staff, professional care.

A systems approach for neonatal hyperbilirubinemia in term and near-term newborns.

Bhutani VK, Johnson LH, Schwoebel A, Gennaro S

School of Medicine at Stanford University, Stanford, California, and Newborn Pediatrics, Pennsylvania Hospital, Philadelphia 19107, USA.

OBJECTIVE: To propose and implement a family-centered systems approach to manage newborn jaundice for safer outcomes. DESIGN: Observational study for known adverse outcomes. SETTING: Semiprivate urban birthing hospital. PATIENTS/PARTICIPANTS: 31,059 well babies discharged as healthy from a cohort of 41,961 live births (1990-2000). INTERVENTIONS: Incremental implementation of a systems approach that incorporated a hospital policy to (a) authorize nurses to obtain a bilirubin (total serum/transcutaneous) measurement for clinical jaundice, (b) universal predischarge total serum bilirubin (at routine metabolic screening), and (c) targeted follow-up, using the bilirubin nomogram (hour-specific, percentile-based total serum bilirubin/transcutaneous bilirubin). MAIN OUTCOME MEASURES: Known adverse outcomes assessed for early- and late-onset severe hyperbilirubinemia before, during, and after systems approach implementation. RESULTS: Adverse outcomes decreased for well babies: exchange transfusion, intensive phototherapy, and readmission. During the study period, there were no "never events" (total serum bilirubin greater than or equal to 30 mg/dl), while "close calls" (total serum bilirubin greater than or equal to 25 mg/dl) were 1 in 15,000 as compared to a reported incidence of 1 in 625. CONCLUSIONS: Reduced adverse events, significant reduction in close calls, and no never events met family expectations for safer experiences with this approach.

Published 2 August 2006 in J Obstet Gynecol Neonatal Nurs, 35(4): 444-55.
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