A Tale of Two Hospitals: The Evolution of Phototherapy Treatment for Neonatal Jaundice

Weiss, Elliott Mark; Zimmerman, Sol S.

doi:10.1542/peds.2012-3651

Cited by 12 publications

(11 citation statements)

References 14 publications

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“…A second example from Bellevue hospital (New York City) illustrates a similar learning opportunity. Bellvue had strict protocols for treating infants with exchange transfusions if the total serum bilirubin levels (TSB) were above 25 and basing exchange transfusions on a test called salicylate displacement tests at lower levels, illustrates the role of informal leaders in system changes [27].…”

Section: Leadership In Organizational Learningmentioning

confidence: 99%

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Organizational Learning in Health Care Organizations

Ratnapalan

Uleryk

2014

Systems

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The process of collective education in an organization that has the capacity to impact an organization's operations, performance and outcomes is called organizational learning. In health care organizations, patient care is provided through one or more visible and invisible teams. These teams are composed of experts and novices from diverse backgrounds working together to provide coordinated care. The number of teams involved in providing care and the possibility of breakdowns in communication and coordinated care increases in direct proportion to sophisticated technology and treatment strategies of complex disease processes. Safe patient care is facilitated by individual professional learning; inter-professional team learning and system based organizational learning, which encompass modified context specific learning by multiple teams and team members in a health care organization. Organizational learning in health care systems is central to managing the learning requirements in complex interconnected dynamic systems where all have to know common background knowledge along with shared meta-knowledge of roles and responsibilities to execute their assigned functions, communicate and transfer the flow of pertinent information and collectively provide safe patient care. Organizational learning in health care is not a onetime intervention, but a continuing organizational phenomenon that occurs through formal and informal learning which has reciprocal association with organizational change. As such, organizational changes elicit organizational learning and organizational learning implements new knowledge and practices to create organizational changes.

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Section: Leadership In Organizational Learningmentioning

confidence: 99%

“…In time, quality assurance tests revealed the poor reproducibility of salicylate displacement. Bellevue stopped doing the test but for years remained partial to exchange transfusion over phototherapy [27].…”

Section: Leadership In Organizational Learningmentioning

confidence: 99%

Organizational Learning in Health Care Organizations

Ratnapalan

Uleryk

2014

Systems

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“…Hypoxemia, perinatal asphyxia, as well as acidosis have been pointed as predisposing risk factors for the occurrence of significant unconjugated hyperbilirubinemia and the need of phototherapy and, by itself, can abide the risk of brain damage [ 11 – 14 ], In accordance with the Literature, although in many cases hypoxemia and acidosis seem to be well tolerated by newborns [ 15 ], a more pronounced hypoxic insult can bear the risk of cerebral damage and/or affect the bilirubin/albumin ratio for binding and the ability of properly process bilirubin to the direct form, increasing the rate of occurrence of unconjugated bilirubin encephalopathy [ 16 ]. Although an interdisciplinary approach could help put neonatal care on a different basis, the role played by hypoxia or acidosis during unconjugated bilirubin brain damage cytotoxicity has been scarcely investigated, and the few available in vitro studies used a model of simultaneous association of both conditions [ 17 ].…”

Section: Introductionmentioning

confidence: 76%

“…Use of umbilical cord blood gas analysis in the assessment of the newborn risk of hyperbilirubinemia has not been previously investigated, although classical studies supported the assumption that hypoxemia, low Apgar score, as well as acidosis may have been pointed as predisposing risk factors for cerebral damage and the occurrence of significant unconjugated hyperbilirubinemia and the need of phototherapy [ 16 ]. However, the role played by hypoxia or hypoxia–ischemia during unconjugated hyperbilirubinemia cytotoxicity has been scarcely investigated.…”

Section: Discussionmentioning

confidence: 99%

Umbilical cord blood acid-base analysis and the development of significant hyperbilirubinemia in near-term and term newborns: a cohort study

et al. 2017

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BackgroundThe recognition, follow-up, and early treatment of neonatal jaundice has become more difficult, since the earlier discharge of newborns from hospitals has become common practice. Since intrapartum hypoxic stress has been pointed as predisposing factor for the occurrence of hyperbilirubinemia risk, we tested the association with the cord blood acid-base index tests.MethodsA cohort of healthy term and near-term newborns underwent umbilical cord hemogasanalysis at birth and capillary heel total serum bilirubin (TSB) pre-discharge, scheduled at 36 h of life, to define the risk of significant hyperbilirubinemia, defined as >9 mg/dL TSB level, ≥ 75th percentile on nomogram of Bhutani et al.ResultsIt was found that among 537 studied neonates, 133 (24.8%) had pre-discharge TSB levels of >9 mg/dL. When the cord blood gas analysis index tests were compared, their acidemia levels were significantly higher than those of neonates with normal TSB levels: HCO3 − (20.71 ± 2.37 vs. 21.29 ± 2.25 mEq/L, p < 0.010), base deficit (−3.52 ± 3.188 vs. -2.68 ± 3.266 mEq/L, p < 0.010), and lactacidemia (3.84 ± 1.864 vs. 3.39 ± 1.737 mEq/L, p < 0.012), respectively. However, logistic regression analysis showed that base deficit was the strongest index of the pre-discharge hyperbilirubinemia risk (OR, 95% CI 0.593; 0.411–0.856), and the hyperbilirubinemia risk increased by 40% with the decrease of 1 mEq/L of base deficit.ConclusionsUmbilical cord blood acidemia and lactacidemia are significant indexes of adaptive mechanisms at birth. The base deficit provides the strongest association with future development of high bilirubin on an hour specific bilirubin nomogram generating risk stratification score in term and near-term neonates.

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“…It is very common to have a long time gap between sufficient research evidence and a change in practice. For example, the use of phototherapy and antenatal corticosteroids was appropriately applied several years, or even decades, after the evidence was provided about their effectiveness. Because even such simple therapies can be difficult to implement, the challenge understandably becomes bigger when it comes to complex clinical interventions , such as skin‐to‐skin contact between parents and infants or family‐centred care.…”

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confidence: 99%