Post‐discharge neonatal hyperbilirubinemia surveillance

Abstract

Aim To assess implementation of the Israel Neonatal Society's 2008 guidelines for universal community assessment of jaundice within 72 hours of discharge from birth hospitalisation. Methods Mothers of newborns were interviewed at Maternal Child Health Clinics in the Jerusalem District, Israel, and asked whether their newborn had been evaluated for jaundice within the recommended time frame. Newborn discharge letters from Israeli hospitals were assessed for appropriate inclusion of instructions for early follow‐up for jaundice. Results Out of 659, 217 (32.9%) mothers whose newborns were at low risk for neonatal hyperbilirubinemia reported an examination within 72 hours of discharge. Eighteen (8.3%) were referred for a bilirubin test. In contrast, 99.1% (109/110) of high‐risk newborns who were specifically invited for a bilirubin test the day following discharge complied. Out of 26, 12 (46.2%) hospital discharge letters specified both a time limit of 72 hours post‐discharge and jaundice as a reason for early follow‐up. Conclusion The early community surveillance rate for jaundice was low, contrasting with near universal compliance in those who received a specific instruction for a post‐discharge bilirubin blood test. Inclusion of specific written instructions in hospital discharge summaries was also low and may contribute to poor implementation of guidelines.

Highlights in this issue

“…Many countries, including Israel, have developed surveillance guidelines to detect hyperbilirubinemia in newborn infants within 72 hours of discharge. Kaplan et al 6 interviewed mothers in the Jerusalem district and found that only 32.9% of the 659 newborn infants who were at low risk for hyperbilirubinemia were examined within this time period, and 8.5% of those were referred for a bilirubin test. In contrast, 99.1% of 110 high‐risk newborn infants received a bilirubin test the day after discharge.…”

Maternal Instruction on Neonatal Jaundice: What Can we Learn from the Stop Kernicterus in Nigeria (SKIN) Experience?

“…Kaplan et al recently highlighted the effectiveness of booking an outpatient appointment before the birth hospitalization discharge (date, time, and site of appointment) to enhance parental compliance with follow-up. 6 Along the same lines, coordinating care between birth hospital care providers and the follow-up physician service is critical to ensure appropriate timely outpatient evaluation and management.…”

Improving post‐discharge neonatal surveillance for the jaundiced newborn

“…In this issue of the Acta, Kaplan and co‐workers report low rates of community surveillance for neonatal jaundice following birth hospital discharge, a not unexpected finding, but one that merits scrutiny and emphasis. The overwhelming majority of newborns born at ≥35 weeks of gestation are discharged before they are 48 hours old whereas the total serum bilirubin (TSB) level typically does not reach its peak until the infant is 4 or 5 days old.…”

“…The data of Kaplan et al remind us that if you want a family to follow your instructions you need to ensure that the instructions are detailed, specific, understandable, relevant and achievable. Parental compliance for those instructed to return ‘when given a specific date, place and time (for bilirubin blood testing)’ was 99%, compared with 67% compliance for those who received ‘specific instruction for early follow‐up’ and 33% for lower‐risk infants whose parents were asked to follow‐up at their community clinic within 72 hours of discharge …”