Increasing utilisation of a rebound hyperbilirubinaemia calculator in two newborn nurseries

Abstract

Neonatal hyperbilirubinaemia requiring phototherapy treatment is a common problem impacting the length of hospital stay and rates of hospital readmission. Previous guidelines included guidance for initiating phototherapy treatment but not for discontinuing phototherapy treatment during initial newborn admission.In response to dissatisfaction from trainees, staff and families regarding the variable approach to discontinuing phototherapy among attending nursery providers, we used quality improvement methodologies to increase utilisation of a rebound hyperbilirubinaemia calculator as a more consistent method for guiding the timing of phototherapy discontinuation. The aim was to increase utilisation of the rebound hyperbilirubinaemia calculator for newborns treated with phototherapy in two newborn nurseries to >90% within 2 years.Sequential interventions focused on increasing provider awareness of the rebound hyperbilirubinaemia calculator and making the calculator simple to access and use.At the university medical centre nursery, the use of the calculator increased from 8.7% to 100%, exceeding the project goal. In the community hospital nursery, there was a statistically significant increase in the rate of utilisation from 3.7% to 79.4%, but this fell slightly below the goal of >90%.Electronic Health Record integration, along with education and addition of prompts to providers, increased utilisation of a rebound hyperbilirubinaemia calculator as a consistent approach for guiding decisions about discontinuing phototherapy treatment in newborns.

Advances for pediatricians in 2022: allergy, anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, genetics, global health, infectious diseases, metabolism, neonatology, neurology, oncology, pulmonology

“…In both infants the prolonged indirect hyperbilirubinemia associated with the finding of a mutation p.Pro364Leu in the bilirubin uridine diphosphate-glucuronosyltransferase gene raised the initial suspicion of Crigler-Najjar syndrome type II. Both infants were treated with phototherapy and phenobarbital, achieving a normalization of bilirubin levels at 1 and 5 months respectively [145][146][147]. The authors suggest that in these patients the concomitant breastfeeding jaundice was not a possible explanation of the clinical picture since a brief interruption of breastfeeding was not effective.…”