Friday, July 13, 2007
This presentation is part of : Measurement Outcomes
Identification of Newborns at High Risk for Hyperbilirubinemia
Mary Jo Schaarschmidt, RN, MSN, CPNP1, Danielle Nabozny, RN, BSN1, and Denise Bickert, RN, BA, MS2. (1) Maternal Child Department, ValleyCare Health System, Pleasanton, CA, USA, (2) Administration, ValleyCare Health System, Pleasanton, CA, USA
Learning Objective #1: describe processes to screen, identify, and intervene for infants with hyperbilirubinemia in order to initiate treatment as soon as possible and help keep families together.
Learning Objective #2: identify the risk factors that may pre-dispose an infant to hyperbilirubinemia and be able to discuss with parents the interventions available to decrease bilirubin levels.

The purpose of this study is to answer the question: “Has the implementation of the guidelines, recommended by JCAHO, AAP and Dr. Bhutani, for a universal systematic assessment to identify newborns at risk for hyperbilirubinemia increased the number of babies identified for treatment prior to discharge and decreased the number of babies needing to be re-admitted for phototherapy?”

Nurses visually assessed jaundiced infants and waited for pediatricians to initiate treatment.  Infants diagnosed with hyperbilirubinemia after discharge needed re-admission.  Now, nurses assess for jaundice and risk factors, measure the transcutaneous and serum bilirubin levels, interpret results on a nomogram, and call for admit orders.

All newborns born in-house were included.  May- August 2005 was the pre-intervention period.  September 2005 - January 2006, the study period, included the use of the TcB and the nurse’s independent interpretation on the nomogram. Out of the 457 well babies in the pre-intervention months, 11 babies(2.4%), were readmitted.  During the study months, 15(3%), of the 508 babies were readmitted.  Out of the 457 well babies in the pre-intervention months, 20 babies(4.4%) were diagnosed in-house.  During the study months, 31 babies out of 508(6.1%) were diagnosed in-house.

The babies identified for treatment prior to discharge did increase.  Although it was not statistically proven that readmits decreased; the fact that there was no increase in re-admits during winter months compared to summer months is a positive impact.  Winter months are notoriously busier months for treatment of hyperbilirubinemia as sunlight can be an effective treatment for jaundice. 

This study provided information to improve education for nurses in identifying risk factors for our patient population and the prevention of hyperbilirubinemia readmissions.  This allows more vigilant observation of newborns for early intervention and focused education for parents on interventions available to help decrease high enough bilirubin levels that necessitate treatment.