Adherence to hyperbilirubinemia guidelines by midwives, general practitioners, and pediatricians in Indonesia

Abstract

Severe hyperbilirubinemia, which may result in kernicterus, is seen more frequently in low and middle-income countries, such as Indonesia, than in high-income countries. In Indonesia midwives, general practitioners (GPs), and pediatricians are involved in the care of jaundiced newborn infants. It is unknown whether the high incidence of severe hyperbilirubinemia in this country is related to a lack of awareness of existing hyperbilirubinemia guidelines issued by, for example, the World Health Organization, the American Academy of Pediatrics, or the Indonesian Health Ministry, or to a lack of adherence to such guidelines. The aim of this questionnaire study was to assess health professionals’ awareness of existing guidelines and their adherence to these guidelines in daily practice. We handed out a ten-question questionnaire to midwives, GPs, and pediatricians that included questions about the professionals themselves as well as clinical questions. The midwives completed 291 questionnaires, the GPs 206, and the pediatricians 154, all of which we used for our analysis. Almost 30% of the midwives and 23% of the GPs were either unaware of any existing guidelines or they did not adhere to them. Only 54% of the midwives recognized the warning signs of severe hyperbilirubinemia correctly, compared to 68% of the GPs and 89% of the pediatricians. Twenty-eight percent of the midwives and 31% of the GPs indicated that their first follow-up visit was after 72 hours, while 90% of them discharged infants after less than 48 hours after birth. The awareness of and adherence to guidelines for preventing and treating hyperbilirubinemia is low amongst the midwives and GPs in Indonesia. This may be an important contributing factor in the high incidence of severe hyperbilirubinemia in Indonesia.

Evaluation of A Mobile Application Tool (BiliNorm) To Improve Care for Newborns with Hyperbilirubinemia in Indonesia

“…We developed a web-based application to make the use of this guideline easier. In a previous study, paediatricians indicated having di culties nding the existing guideline, which hampered their use of it [3].…”

“…This is based on the possible diagnosis of kernicterus spectrum disorder (KSD) and consists of a scoring system that includes the highest TSB level, the presence of risk factors, the ndings of neurological examinations performed at rst presentation and at follow-up, the presence of enamel dysplasia, the results of the auditory brainstem response (ABR) test, and MRI ndings [10]. The result is given as one of four categories: de nite kernicterus (10)(11)(12)(13)(14), probable kernicterus (6-9), possible kernicterus (3)(4)(5) and no kernicterus (0-2). This feature might help professionals to prepare for the possible long-term complications of severe hyperbilirubinemia.…”

“…Guidelines for diagnosing and treating hyperbilirubinemia have been created to assist health care workers who care for newborn infants, such as midwives, general practitioners and paediatricians. In a previous study, we found that awareness of and adherence to these guidelines is low amongst midwives and general practitioners in Indonesia [3]. Only 23% of the general practitioners and 29% of the midwives indicated using these hyperbilirubinemia management guidelines.…”

“…A previous study in the USA reported that almost 60% of paediatricians initiated PT at TSB levels lower than those recommended by the American Academy of Pediatrics (AAP) in newborns more than 72 hours of age, demonstrating that paediatricians do not always adhere to guidelines [4]. Low adherence to guidelines by health care workers may be caused by di culty accessing the available guidelines [3,5]. Fifty percent of paediatricians in Surabaya indicated having di culties obtaining access to a guideline [3].…”

“…Low adherence to guidelines by health care workers may be caused by di culty accessing the available guidelines [3,5]. Fifty percent of paediatricians in Surabaya indicated having di culties obtaining access to a guideline [3]. Recently, a new guideline for the diagnosis and treatment of hyperbilirubinemia was issued by the Indonesian Paediatric Society [6].…”